Vitamin A, Administration

The vitamin A needs of the body are by no means centered in any one organ or tissue. It is necessary for vision, for tooth and bone development, for maintenance of healthy epithelial tissue in the skin and in many organs, for reproduction, etc. It is to be expected that deficiency would be exhibited in many ways and that in different individuals the symptoms would not be the same. The benefits of vitamin A administration may thus appear very different in different individuals, and this helps to explain why many kinds of benefits (part of which are probably real) have been ascribed (by physicians as well as others) to vitamin A administration. A substance with such diverse functions is bound to show different effects in different individuals, and, of course, for some individuals who have low requirements and get plenty in their food, its administration will appear to be wholly without effect. Otto Bessey, in discussing the problem of nutrition, has used vitamin A as an illustration of how widely different levels are needed to maintain different functions in experi-... 

People with severe hypertriglyceridemia associated with Type V hyperlipoproteinemia may be at increased risk of hypervitaminosis A, even with moderate degrees of vitamin A supplementation (1199). Long-term vitamin A administration is associated with an increase in serum cholesterol and serum triglyceride concentrations (1200) and consequently might be linked with atherosclerosis (SEDA-8, 345) (1201,1202). 

Bone and Teeth Defective formation of enamel of teeth. Abnormal bone and tooth formation are reversed by vitamin A administration. Carbohydrate metabolism Vitamin A helps glucose synthesis from triose molecules. Reproduction Retinol and retinal are essential for normal reproduction. 

Geubel AP, De Galocsy C, Alves N, Rahier J, Dive C. Liver damage caused by therapeutic vitamin A administration estimate of dose-related toxicity in 41 cases. Gastroenterology 1991 100(6) 1701-9. 

Rahman MM, Mahalanabis D, Hossain S, Wahed MA, Alvarez JO, Siber GR, Thompson C, Santosham M, Fuchs GJ. Simultaneous vitamin A administration at routine immunization contacts enhances antibody responses to diphtheria vaccine in infants younger than six months. J Nutr 1999 129(12) 2192-5. 

In regard to the possibility of an overdosage of vitamin D, Bedin (1947) reported that vitamin A can prevent toxic symptoms caused by high doses of vitamin D. The vitamin A administration, as mentioned in Section II, 8, may be beneficial for this and for other reasons. At therapeutic levels, vitamin A increases the good effects of vitamin D. 

Agarwal DK, Pandey CM, Agarwal KN (1995) Vitamin A administration and preschool child mortality. Nutr Res 15 669-680... 

A common problem associated with the administration of the bile acid sequestrants is constipation. Constipation may be severe and may occasionally result in fecal impaction. Hemorrhoids may be aggravated. Additional adverse reactions include vitamin A and D deficiencies, bleeding tendencies (including gastrointestinal bleeding) caused by a depletion of vitamin K, nausea, abdominal pain, and distention. 

The nurse must assess the patient for additional evidence of bleeding until the PT is below 1.5 times die control value or until the bleeding episodes cease. The PT generally returns to a safe level within 6 hours of administration of vitamin Kt. Administration of whole blood or plasma may be necessary if severe bleeding occurs because of the delayed onset of vitamin Kx. 

Vitamin K is a fat-soluble vitamin cofactor for the activation of factors II, VII, IX, and X in the liver. Almost all neonates are vitamin K-deficient at as a result of (1) insignificant transplacental vitamin K crossover, (2) lack of colonization of the colon by vitamin K-producing bacteria, and (3) inadequate dietary vitamin K intake (especially in breast-fed infants because human milk contains less vitamin K than infant formula or cow s milk). Vitamin K-deficiency bleeding (VKDB) refers to bleeding attributable to vitamin K deficiency within first 6 months of life. It occurs in three general time frames early (0-24 hours), classic (1-7 days), and late (2-12 weeks). Early onset occurs rarely and usually is associated with maternal ingestion of anticonvulsants, rifampin, isoniazid, and warfarin. Classic vitamin K-dependent bleeding usually results from the lack of prophylactic vitamin K administration in... 

Orlistat reduces the absorption of fat-soluble vitamins. Daily intake of a multivitamin containing vitamins A, D, E, and K, as well as 3-carotene, is recommended. Patients should take the multivitamin 2 hours prior to or after the dose of orlistat.31 Since availability of vitamin K may decline in patients receiving orlistat therapy, close monitoring of coagulation status should occur with concomitant administration of warfarin.31 Administration of orlistat in conjunction with cyclosporine can result in decreased cyclosporine plasma levels. To avoid this interaction, cyclosporine should be taken 2 hours preceding or following the dose of orlistat. Additionally, cyclosporine levels should be monitored more frequently.31... 

Other potential adverse effects include impaired absorption of fat-soluble vitamins A, D, E, and K hypernatremia and hyperchloremia GI obstruction and reduced bioavailability of acidic drugs such as warfarin, nicotinic acid, thyroxine, acetaminophen, hydrocortisone, hydrochlorothiazide, loperamide, and possibly iron. Drug interactions may be avoided by alternating administration times with an interval of 6 hours or greater between the BAR and other drugs. 

Vitamin A. To overcome the difficulty of identification, vitamin A can be used as a label. The changes in the blood vitamin A curve following the administration of vitamin A in oil provide similar information to that given by the chylomicrograph. In malabsorption due to enteropathy the curve is depressed and delayed, and in pancreatic lipase deficiency it is markedly flattened. The use of vitamin A in oil and in aqueous dispersion is similar in principle to the use of labeled triolein and oleic acid (B4, G3, L4). 

By inhalative application of vitamin A, an accumulation of peripheral vifamin A stores is achieved. For the Irmg and the respiratory epithelium, concentrations in the range of 1-20 (ig/g were obtained (Biesalski, 1990). Looking at quantitative concentrations in the respiratory epithelium and in the mixed epithelium of the nasal mucosa yielded an accumulation of vifamin A — after topical administration in different animal species — in the epithelium of the nose increased by factor 10-100 (in human of factor 5-20) compared to the concentrations of the respiratory mucosa (Lewis, 1973). 

The obtained results confirm earlier findings where vitamin A-deficient rats were used to prove the uptake of retinyl esters into lung, liver, kidney, and plasma after inhalation thereof (Biesalski, 1996). However, long-term topical administration of high vitamin A concentrations is a well-established therapy in atrophic rhinitis, rhinitis sicca, and metaplastic changes in the nasal or ocular epithelium (Deshpande et ah, 1997 Simm, 1980). The application leads to the normalization of mucous membranes and reappearance of a normal function with no side effects. 

Itching associated with retention of bile acids is ameliorated by treatment with the bile acid binding resin cholestyramine. Fat soluble vitamin (A, D and K) deficiency may require administration of supplements. Direct toxic effects of alcohol associated with dietary deficiency may require soluble B vitamin administration. 

Vitamins are vital for normal metabolism in body. They vary in their chemical structure and are supplied in very small quantity in diet, because they are not synthesized in body or their rate of production is not sufficient for maintenance of health. Vitamin deficiency leads to development of deficiency symptoms. Different vitamin preparations are available for treatment and prophylaxis. Most of the vitamins are nontoxic but on chronic administration can cause toxicity especially vitamin A and D. 

As vitamin A and carotene are in the fat portion of milk, the vitamin A activity is removed with the milk fat during separation into cream and lowfat and skim milks. Consequently, standards of identity established by the U.S. Food and Drug Administration (FDA) mandate the addition of vitamin A (e.g., retinyl palmitate) to fluid lowfat and skim milks and to nonfat dry milk to a level approximating that found in whole milk from cows on summer pasture. That is, at least 2000 IU of vitamin A must be present in each quart of lowfat and skim milk (FDA... 

The leveisal of the oxidative pathway of vitamin A (retinol —r retinal —>-retinoic add) does not occur in the body, When retinoic acid is feci to animals, even in relatively large doses, there is no storage and, in fact, die molecule is rapidly metabolized and cannot be found several hours after administration. The metabolic products have not been fully identified. Several fractions from liver or intestine, isolated after administering retinoic add marked with carbon-14, have been shown to have biological activity. 

Unusual features of vitamin A as observed by some investigators include (1) decreases serum cholesterol in large-quantity administration (chicks) (2) dietary protein required to mobilize liver reserves of vitamin A (3) decreased quantities in tumors (4) coenzynre Q10 accumulates in A-deficient rat liver (5) Ubichromenol-50 accumulation in A-deficient rat liver (6) retinoic acid functions as vitamin A except for visual and reproductive functions (7) anti-infection properties and anti-allergic properties (8) decreases basal metabolism (9) detoxification of poisons in the liver aided by vitamin A and (10) vitamin A is involved in triose —> glucose conversions. 

Tanner, J.T., Barnett, S.A., and Mountford, M.K. 1993. Analysis of milk based infant formula. Phase V. Vitamins A and E, folic acid, and pantothenic acid Food and Dairy Administration-Infant Formula Council Collaborative study. J. AOAC Int. 76 399-401. 

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