eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin A Toxicity: Differential Diagnoses & Workup

Author: Mohsen S Eledrisi, MD, FACP, FACE, Consultant, Department of Internal Medicine, Division of Endocrinology and Metabolism, King Abdulaziz National Guard Medical Center, Saudi Arabia
Coauthor(s): Kevin McKinney, MD, Assistant Professor, Department of Medicine, Division of Endocrinology and Metabolism, University of Texas Medical Branch at Galveston; Mohammad S Shanti, MD, ABEM, Chair, Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Differential Diagnoses

Toxicity, Iron

Other Problems to Be Considered

Vitamin D toxicity
Skin pigmentation of carotenemia (observed with consumption of large amounts of colored fruits and vegetables)

Workup

Laboratory Studies

  • Serum electrolytes, if vomiting or diarrhea is present
  • Serum calcium (hypercalcemia may be observed6 )
  • Liver function tests
  • Complete blood count (CBC) for anemia, leukopenia, or thrombocytopenia
  • Vitamin A assessment by serum retinol concentrations (This may be helpful if the level is markedly high. However, in mild conditions, it may not be sensitive.)
  • High-performance liquid chromatography (HPLC) - Johnson-Davis et al reported on a modified form of HPLC they developed to shorten analysis time for serum concentrations of vitamins A and E.7 Using their modifications — a high-throughput analytic column and small diameter tubing — to determine pediatric reference intervals for the 2 vitamins in 1136 healthy children, the authors stated that their technique reduced run-time by 60%, mobile phase consumption by 39%, and sample injection volume by 50%.

Imaging Studies

  • Hand radiography for periosteal calcifications
  • Computed tomography (CT) scanning of the brain in the presence of neurologic abnormalities
  • Bone mineral density testing to evaluate the effect of long-term vitamin A intoxication on reducing bone density and causing osteoporosis8

Other Tests

  • Electrocardiogram (ECG) to evaluate the effects of hypercalcemia

Procedures

  • Lumbar puncture may be needed in patients with increased intracranial pressure to prevent its complications.

More on Vitamin A Toxicity

Overview: Vitamin A Toxicity
Differential Diagnoses & Workup: Vitamin A Toxicity
Treatment & Medication: Vitamin A Toxicity
Follow-up: Vitamin A Toxicity
References
Further Reading
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References

  1. Maqbool A, Stallings VA. Update on fat-soluble vitamins in cystic fibrosis. Curr Opin Pulm Med. Nov 2008;14(6):574-81. [Medline].

  2. Mawson AR. On the association between low resting heart rate and chronic aggression: retinoid toxicity hypothesis. Prog Neuropsychopharmacol Biol Psychiatry. Mar 17 2009;33(2):205-13. [Medline].

  3. Tan KP, Kosuge K, Yang M, et al. NRF2 as a determinant of cellular resistance in retinoic acid cytotoxicity. Free Radic Biol Med. Dec 15 2008;45(12):1663-73. [Medline].

  4. Genaro Pde S, Martini LA. Vitamin A supplementation and risk of skeletal fracture. Nutr Rev. Feb 2004;62(2):65-7. [Medline].

  5. Miksad R, Ledinghen V, McDougall C, et al. Hepatic hydrothorax associated with vitamin A toxicity. J Clin Gastroenterol. 2002;34:275-279. [Medline].

  6. Bhalla K, Ennis DM, Ennis ED. Hypercalcemia caused by iatrogenic hypervitaminosis A. J Am Diet Assoc. 2005;105:119-121. [Medline].

  7. Johnson-Davis KL, Moore SJ, Owen WE, et al. A rapid HPLC method used to establish pediatric reference intervals for vitamins A and E. Clin Chim Acta. Jul 2009;405(1-2):35-8. [Medline].

  8. Barker ME, Blumsohn A. Is vitamin A consumption a risk factor for osteoporotic fracture?. Proc Nutr Soc. 2003;62:845-850. [Medline].

  9. Bates CJ. Vitamin A. Lancet. Jan 7 1995;345(8941):31-5. [Medline].

  10. Hathcock JN. Vitamins and minerals: efficacy and safety. Am J Clin Nutr. Aug 1997;66(2):427-37. [Medline].

  11. Hathcock JN, Hattan DG, Jenkins MY, et al. Evaluation of vitamin A toxicity. Am J Clin Nutr. Aug 1990;52(2):183-202. [Medline].

  12. Michaelsson K, Lithell H, Vessby B, et al. Serum retinol levels and the risk of fracture. N Engl J Med. 2003;348:287-294. [Medline].

  13. Nagai K, Hosaka H, Kubo S, et al. Vitamin A toxicity secondary to excessive intake of yellow-green vegetables, liver and laver. J Hepatol. Jul 1999;31(1):142-8. [Medline].

  14. O'Donnell J. Polar hysteria: an expression of hypervitaminosis A. Am J Ther. 2004;11:507-516. [Medline].

  15. Olson JA. Adverse effects of large doses of vitamin A and retinoids. Semin Oncol. Sep 1983;10(3):290-3. [Medline].

  16. Penniston KL, Tanumihardjo S. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006;83:191-201.

  17. Perrotta S, Nobili B, Rossi F, et al. Infant hypervitaminosis A causes severe anemia and thrombocytopenia: evidence of a retinol-dependent bone marrow cell growth inhibition. Blood. 2002;99:2017-2022. [Medline].

  18. Sharieff GQ, Hanten K. Pseudotumor cerebri and hypercalcemia resulting from vitamin A toxicity. Ann Emerg Med. Apr 1996;27(4):518-21. [Medline].

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Further Reading

Related eMedicine topics:
Avitaminosis A
Carotenemia [Dermatology]
Carotenemia [Pediatrics: General Medicine]
Toxicity, Vitamin
Vitamin A Deficiency
Vitamin E Toxicity

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Keywords

vitamin A toxicity, vitamin A, retinol, carotene, vitamin carotene, retinoid, carotenemia, isotretinoin, Accutane, carotenes, vitamin A alcohol, retinol ester, vitamin A overdose, vitamin A poisoning, dietary vitamin A, vitamin A supplements, provitamin A carotenoids

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Contributor Information and Disclosures

Author

Mohsen S Eledrisi, MD, FACP, FACE, Consultant, Department of Internal Medicine, Division of Endocrinology and Metabolism, King Abdulaziz National Guard Medical Center, Saudi Arabia
Mohsen S Eledrisi, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kevin McKinney, MD, Assistant Professor, Department of Medicine, Division of Endocrinology and Metabolism, University of Texas Medical Branch at Galveston
Kevin McKinney, MD is a member of the following medical societies: Texas Medical Association
Disclosure: Nothing to disclose.

Mohammad S Shanti, MD, ABEM, Chair, Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center
Mohammad S Shanti, MD, ABEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Harris C Taylor, MD, Clinical Professor of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine
Harris C Taylor, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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