A 10 month old child weighing 8 kg is brought to the clinic due to repeated vomiting and persistent diarrhoea. On ophthalmological examination, Bitot’s spots are seen on the bulbar conjunctiva of both eyes. What is the recommended schedule of vitamin A therapy to be given to this child?

## **Core Concept**
The child's symptoms of repeated vomiting, persistent diarrhea, and the presence of Bitot's spots on the bulbar conjunctiva are indicative of vitamin A deficiency. Vitamin A deficiency can lead to night blindness, impaired immune function, and in severe cases, conditions like xerophthalmia, which includes the presence of Bitot's spots. The World Health Organization (WHO) provides guidelines for the treatment of vitamin A deficiency.

## **Why the Correct Answer is Right**
The recommended schedule for vitamin A therapy in a child with deficiency, as per WHO guidelines, is to administer vitamin A immediately and then repeat the dose the next day and again after 2 weeks. The correct regimen for treating vitamin A deficiency, especially in cases with clinical manifestations like Bitot's spots, involves giving immediate doses to rapidly replenish stores and prevent further complications.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option suggests a single dose, which is insufficient for treating vitamin A deficiency with clinical manifestations like Bitot's spots, as it doesn't ensure adequate replenishment of vitamin A stores.
- **Option B:** This option does not match the standard recommended schedule for treatment.
- **Option D:** This option suggests a longer interval or different dosing schedule that does not align with the immediate need to correct deficiency and prevent progression of disease.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that vitamin A deficiency is a significant public health problem in many developing countries and can be effectively treated and prevented with vitamin A supplementation. The presence of Bitot's spots is a pathognomonic sign of vitamin A deficiency. The WHO recommends the following vitamin A supplementation schedule: immediately, then a repeat dose the next day, and a third dose after 2-4 weeks.

## **Correct Answer:** .

✓ Correct Answer: D. 1 lakh international units intramuscularly on day 0, 1, 28