eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin E Toxicity: Differential Diagnoses & Workup

Author: Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Coauthor(s): Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Contributor Information and Disclosures

Updated: Aug 12, 2008

Differential Diagnoses

Other Problems to Be Considered

An elevated international normalized ratio (INR) may be due to excessive doses of warfarin anticoagulants in patients taking these medications. Vitamin K deficiency and liver failure can prolong the PT and raise the INR.

Workup

Laboratory Studies

  • Monitor PT in patients who are taking anticoagulants concurrently with vitamin E or in patients suggested to have vitamin K deficiency while taking vitamin E, because the PT may be elevated.
  • The plasma concentration of alpha tocopherol (normal, 6-14 mcg/mL) can be measured to confirm that high levels of vitamin E are in the blood.

Imaging Studies

  • Perform a computed tomography (CT) scan of the brain, without contrast, only if the PT is significantly prolonged and the patient has either a decreased level of consciousness or a focal neurologic deficit.

More on Vitamin E Toxicity

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

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  3. Corrigan JJ Jr, Marcus FI. Coagulopathy associated with vitamin E ingestion. JAMA. Dec 2 1974;230(9):1300-1. [Medline].

  4. Diplock AT. Safety of antioxidant vitamins and beta-carotene. Am J Clin Nutr. Dec 1995;62(6 Suppl):1510S-6S. [Medline]. [Full Text].

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  6. Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol. Aug 2001;21(8):1320-6. [Medline]. [Full Text].

  7. Hathcock JN, Azzi A, Blumberg J, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr. Apr 2005;81(4):736-45.

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  9. [Best Evidence] Cook NR, Albert CM, Gaziano JM, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Intern Med. Aug 13-27 2007;167(15):1610-8. [Medline].

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  11. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. Mar 16 2005;293(11):1338-47. [Medline]. [Full Text].

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  15. Orrell RW, Lane RJ, Ross M. A systematic review of antioxidant treatment for amyotrophic lateral sclerosis/motor neuron disease. Amyotroph Lateral Scler. Mar 14 2008;1-16. [Medline].

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  19. Leppala JM, Virtamo J, Fogelholm R, et al. Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. Arterioscler Thromb Vasc Biol. Jan 2000;20(1):230-5. [Medline]. [Full Text].

  20. Handelman GJ. High-dose vitamin supplements for cigarette smokers: caution is indicated. Nutr Rev. Oct 1997;55(10):369-70. [Medline].

  21. Bardosi A, Dickmann U. Necrotizing myopathy with paracrystalline inclusion bodies in hypervitaminosis E. Acta Neuropathol (Berl). 1987;75(2):166-72. [Medline].

  22. Brown BG, Crowley J. Is there any hope for vitamin E?. JAMA. Mar 16 2005;293(11):1387-90. [Medline].

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  24. Kappus H, Diplock AT. Tolerance and safety of vitamin E: a toxicological position report. Free Radic Biol Med. 1992;13(1):55-74. [Medline].

  25. Kitagawa M, Mino M. Effects of elevated d-alpha(RRR)-tocopherol dosage in man. J Nutr Sci Vitaminol (Tokyo). Apr 1989;35(2):133-42. [Medline].

  26. Meydani SN, Meydani M, Blumberg JB, et al. Assessment of the safety of supplementation with different amounts of vitamin E in healthy older adults. Am J Clin Nutr. Aug 1998;68(2):311-8. [Medline].

  27. Meydani SN, Meydani M, Rall LC. Assessment of the safety of high-dose, short-term supplementation with vitamin E in healthy older adults. Am J Clin Nutr. Nov 1994;60(5):704-9. [Medline].

  28. Meyers DG, Maloley PA, Weeks D. Safety of antioxidant vitamins. Arch Intern Med. May 13 1996;156(9):925-35. [Medline].

  29. Omaye ST. Safety of megavitamin therapy. Adv Exp Med Biol. 1984;177:169-203. [Medline].

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Further Reading

Related eMedicine topics:
 Toxicity, Vitamin
Vitamin E Deficiency
Vitamin K Deficiency

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Keywords

vitamin E toxicity, hypervitaminosis E, vitamin poisoning, vitamin toxicity, vitamin E, alpha tocopherol, alpha-tocopherol, all-rac-alpha-tocopherol acetate, RRR–alpha tocopherol, RRR-alpha-tocopherol, antioxidant, free radical scavenger, fat-soluble vitamin, Alpha-Tocopherol, Beta Carotene Cancer Prevention Study, fatal subarachnoid hemorrhage, increased risk of bleeding, increased prothrombin time, necrotizing enterocolitis, intracranial hemorrhage, vitamin K

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Contributor Information and Disclosures

Author

Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Angela Gentili, MD is a member of the following medical societies: American Geriatrics Society
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Robert A Adler, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Bone and Mineral Research, and Endocrine Society
Disclosure: Eli Lilly Consulting fee Consulting

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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