Vitamin A Toxicity Follow-up

  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Jan 3, 2012
 

Further Inpatient Care

  • Admit patients with the following symptoms to the hospital:
    • Altered mental status
    • Severe dehydration
    • Neurologic deficits
    • Metabolic derangements
    • Liver toxicity
    • Significant hypercalcemia
  • Patients with increased intracranial pressure may need therapeutic lumbar punctures or further treatment with medications such as diuretics and mannitol.
  • Patients with symptomatic hypercalcemia require the following:
    • Close monitoring
    • Treatment with intravenous fluids and diuretics
    • Additional therapy, including pamidronate, calcitonin, corticosteroids, or mithramycin
    • Discontinuation of vitamin A
Next

Further Outpatient Care

  • Follow-up is recommended with a primary care physician.
  • The pigmentation of carotenemia usually disappears with the omission of carrots from the diet.
  • Patients on isotretinoin should be evaluated by their dermatologist for consideration of stopping the drug.
Previous
Next

Deterrence/Prevention

Education on the proper required daily allowance dose of vitamin A should be provided to modify the individual's current use of vitamin supplements.

Previous
Next

Prognosis

  • Prognosis is generally good.
  • Mortality is rare.
Previous
Next

Patient Education

Patient education is an important part of management because many cases are due to long-term toxicity from dietary or drug supplements.

Previous
 
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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Romesh Khardori, MD, PhD, FACP  Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

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.

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. Ackermans MM, Zhou H, Carels CE, Wagener FA, Von den Hoff JW. Vitamin A and clefting: putative biological mechanisms. Nutr Rev. Oct 2011;69(10):613-24. [Medline].

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

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

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

  13. Hayman RM, Dalziel SR. Acute vitamin A toxicity: A report of three paediatric cases. J Paediatr Child Health. Jun 17 2011;[Medline].

  14. 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].

  15. 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].

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

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

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

  19. 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].

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

  21. Takasaki J, Ono K, Yoshiike Y, Hirohata M, Ikeda T, Morinaga A, et al. Vitamin A has Anti-Oligomerization Effects on Amyloid-ß In Vitro. J Alzheimers Dis. Jan 1 2011;27(2):271-80. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.