A 12-month-old infant accidentally received three consecutive monthly mega-doses of vitamin A (200,000 IU each). Two days after the last dose he develops vomiting, drowsiness, and a tense bulging anterior fontanelle. CSF examination is normal. What is the most appropriate management?
- A Stop further vitamin A and give supportive care only ✓
- B Lumbar puncture drainage of CSF and acetazolamide
- C Emergency ventriculoperitoneal shunt
- D High-dose corticosteroids for six weeks
Correct answer: A. Stop further vitamin A and give supportive care only
Explanation
Acute vitamin B toxicity raises intracranial pressure, producing vomiting, drowsiness, and a bulging fontanelle that mimics meningitis or a space-occupying lesion, but CSF remains normal. In infants the raised intracranial pressure is self-limiting over days once the vitamin is stopped, and management is purely supportive with serial observation. Shunting and prolonged steroids are reserved for chronic refractory cases, which are rare.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.