Vitamin A defintake of 1

Vit A def
intake of <180mcg retinol.
Causes:
1.Diarrhea
2worms
3increased metabolic demand in measles,RTI.
C/f:
1subclinical
rt,ut,intenst.Epith.affected
2early feat
defective dark adaptation
3xerophthalmia
who class
x1a-conjuctival xerosis
x1b-bitots spots
x2-corneal xerosis
x3a--"--- ulceration
x3b--"--"-->1/3cornea
XN Night blindness
XE Fundal changes
xs corneal scaring
Rx
50000,1lac,2lacIU in children <6mnth,6-12mont,>1yr
prevention
1lac unit vit a at 9months
TOXICITY
ACUTE
headache,vomiting,dizines
s/o raised ICT-PSUEDOTUMOR CEREBRI
CHRONIC
anorexia,itchy skin,wt loss
teratogenic

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NEPHROTIC SYNDROME

I.. Minimal change nephrotic syndrome
II. Nephrotic syndrome with significant lesion -

I.. Minimal change nephrotic syndrome

80 % of neph syndromes
- Clinical features
edema around eye, pitting, graduallly generalised, sustained elevation of BP
LAB findings-
heavy proteinuria, gross hematuria, hyaline casts, blodd level of igg low , igm high, protein selectivity low ratio
MANAGEMENT
- high protein diet
- no extra salts
rapid fliud losss should nt be attempted
- furosemide 1-4 mg / kg
- prednosolone 2mg/kg

management of relapse
- prednisolne 2mg/kg 2 wks
- treatment of frequent relapses
* Alternate day prednisolone 0.3- 0.7 mg/kg 10 mnths

COMPLICATIONS

1. Edema
2. infection
3. thrombotic complication
4. steroid toxicty
5. Acute renal failure

. II. Nephrotic syndrome with significant lesion -

Significant glomerular abnormalities
1. Mesangial proliferative GN
2. Focal segmental glomerulosclerosis
3. Membranoproliferative GN

Supportive care of resistent nephrotic syndrome
i.v. albumin
ACE inhibitors