A 9-month-old infant receives a single 200,000 IU oral dose of vitamin A during a national supplementation round. Six hours later he develops vomiting, lethargy, and a tense bulging anterior fontanelle. CT scan shows no mass lesion or hydrocephalus.

• A Immediate lumbar puncture and empirical antibiotics
• B Intravenous mannitol and dexamethasone
• C Emergency ventriculoperitoneal shunt insertion
• D Observation only, as symptoms are self-limiting ✓

Explanation

Acute vitamin A toxicity can occur after a single megadose exceeding about 200,000 IU in infants, presenting within hours with vomiting, drowsiness, and raised intracranial pressure manifesting as a bulging fontanelle. This benign intracranial hypertension is transient and resolves spontaneously within 1 to 2 days without sequelae, so supportive observation suffices. The absence of fever, meningismus, or focal findings argues against bacterial meningitis, and surgical or osmotic interventions are unwarranted for a self-limiting process.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.