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blindness) • Increased risk of infections (Viral is more). Excess results in: • Raised intracranial pressure, irritability,dry skin, hair loss, brittle bones 2. Thiamin (B1) Carbohydrate metabolism, decarboxylation Synthesis of fatty acid and Ribose (for RNA) Deficiency results in: Beriberi manifested by • Anorexia, emotional disturbances. Parasthesia, weakness, gastrointestinal symptoms • Dry beriberi (peripheral neuropathy, mental confusion,nystagmus) • wet beriberi ( biventricular cardiac enlargement, systemic venous hypertension, bounding pulse) • Infantile beriberi (acute cardiac failure) 3. Riboflavine (B2) • Coenzyme in oxidative –reduction reaction Pediatric Nursing and child health care 97 Deficiency results in; • Angular stomatitis, cracking and fissuring of lips • Glositis, papillary atrophy • Scrotal or vulvae dermatitis • Photophobia, corneal vascularisation • Anaemia, hair loss , ataxia • Personality changes, retarded intellectual development 4. Niacin (nicotinic Acid) • Oxidative –reduction reactions , fat synthesis, glucolysis • Deficiency results in: Pellagra (dermatitis, diarrhea, dementia) • loss of weight, poor appetite, sore mouth, indigestion • insomina, confusion • skin erythema, pruritus, discoloration, flaking 5. Pyriodoxine (B6) • Coenzyme in amino acid metabolism and • Muscle glucogen phosphorylase Deficiency results in: Infants: hyperirritability, convulsions, weakness anemia, and dermatitis 6. Folic Acid • Co-enzyme in pyrimidine and purine synthesis (for DNA,RNA) Pediatric Nursing and child health care 98 Deficiency results in: • Megaloblastic anaemia • Mild peripheral neuropathy, retarded growth • Psychiatric disturbances, gastrointestinal disturbances 7. Ascorbic Acid (vitamine C) • Formation of collagen, amino-acid metabolism • Iron and copper metabolism • Protection against free radicals (oxidents) Deficiency results in: Scurvy • ulceration ,poor wound healing, anemia • Scurvy: irritability , unproductive cough, bone tenderness, sub-periosteal hemorrhages 8. Vitamin D: • Calcium and phosphate homeostasis • Normal mineralisation of bone and teeth Deficiency result in: • Rickets, Osteomalacia Excess result in: • Hypocalcaemia, ectopic calcification • Failure to thrive Pediatric Nursing and child health care 99 9. Vitamin E (tocopherol): • Antioxidant (protects against free radicals) • Preserve cell membrane integrity Deficiency result in: • Hemolytic anemia, skin changes • Encephalomalacia 10. Vitamin K Synthesis of coagulation factors Deficiency results in: • Coagulophathy: haematuria, hematomas, and heamorragic disease of newborn • Hemolytic anemia may be caused by the water soluble form of vitamin K Iron deficiency Anemia: Anemia refers to a deficit of red blood cells or hemoglobin in the blood. It is the most frequent hematological disorder encounter in children. Etiology: • 1.Blood loss • 2.Impairment of red blood cell production a. Nutritional deficiency • Iron deficiency • Folic acid deficiency Pediatric Nursing and child health care 100 Vitamin B12 deficiency b) Decreased erythrocyte production: • Pure red cell anemia • Secondary hemolytic anemia’s associated with infection, renal disease, and chronic disorders Aplastic anemias Invasion of bone marrow by A, Leukemia B, Tumors 3. Increased erythrocyte destruction a. Drugs and chemicals b. Infections c. Antibody reaction d. Burns e. Poisons including lead poisoning f. Abnormalities of the red cell marrow g. Hemolytic disease of the newborn h. Abnormal hemoglobin synthesis e.g. sickle cell disease Clinical Manifestations: 1. The condition may be acute or chronic 2. Early symptoms a. Listlessness b. Fatigability c. Anorexia Pediatric Nursing and child health care 101 3. Late symptoms a. Pallor b. weakness c. tachycardia d. Palpitation 4. Eventual symptoms a. Mental and physical retardation b. Cardiac enlargement and symptoms of congestive heart failure c. Inability to carry out the usual childhood activities 5. Prognosis a. Varies with the type of anemia b. death may result because of cardiac failure Nursing Responsibility: 1. Assessment of the child’s condition Building resistance to infection Administering blood transfusion as ordered Nursing management: 1. Administer iron as ordered by the
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