Vitamin A Toxicity Workup

  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Mar 27, 2012
 

Laboratory Studies

Laboratory studies may include the following:

  • Serum electrolytes, if vomiting or diarrhea is present
  • Serum calcium (hypercalcemia may be observed[7] )
  • Liver function tests
  • Complete blood count (CBC) for anemia, leukopenia, or thrombocytopenia
  • Vitamin A assessment by serum retinol concentrations
  • High-performance liquid chromatography (HPLC)

Vitamin A assessment by serum retinol concentrations may be helpful if the level is markedly high. However, in mild conditions, it may not be sensitive.

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.[8] 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%.

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Imaging Studies

Imaging studies may include the following:

  • 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 osteoporosis[9]
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Other Tests

Electrocardiogram (ECG) may be used to evaluate the effects of hypercalcemia.

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Procedures

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

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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.

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. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. Mar 14 2012;3:CD007176. [Medline].

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

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

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

  8. 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].

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

  10. 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].

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

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

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

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

  15. 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].

  16. 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].

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

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

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

  20. 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].

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

  22. 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].

 
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