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Attempts to define the minimal serum level of vitamin A required for normal visual function in a patient with severe fat malabsorption
Author(s) -
Wachtmeister Lillemor,
Björkhem Ingemar,
Diczfalusy Ulf,
Emami Ali
Publication year - 1988
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.1988.tb04607.x
Subject(s) - malabsorption , vitamin , medicine , retinol , vitamin a deficiency , endocrinology , erg , fat soluble vitamin , blindness , ophthalmology , retinal , optometry
. A case with severe malabsorption of fat soluble vitamins is described. The malabsorption developed after an intestinal bypass operation due to morbid obesity. Night blindness occurred as the first symptom of vitamin A deficiency. The cone visual sensory threshold was elevated about one log unit and the rod threshold abot two and a half log units. No changes of the a‐ and b‐waves of the electroretinogram (ERG) was observed. However, during the initial phase of very low serum reninol level (0.21 μmol/l) the summed amplitudes of the oscillatory potentials (OPs) were lower. After parenteral therapy with vitamin A the night blindness disappeared and the dark‐adapted rod and cone threshold sensitivity recovered to normal. However, the time‐course of rod adaptation first reached normal levels after 5 months. The amplitudes of the OPs of the ERG response returned to normal when the serum retinol level had increased close to normal. Serum retinol levels of 0.7 μmol/l or higher were always associated with normal or close to normal dark‐adapted rod sensitivity. However, a normal serum retinol level (>0.95 μmol/l) and a normal dark‐adapted rod threshold sensitivity were not always associated with a normal time‐course of the rod adaptation. It is concluded, that the maintenance dosage of vitamin A must be individualized and that patients who have undergone jejunoilea bypass surgery must be carefully monitored for vitamin A deficiency by both serum levels and dark adaptation measurements.