Vitamin E Toxicity Follow-up

  • Author: Angela Gentili, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Mar 27, 2012
 

Further Inpatient Care

Patients with vitamin E toxicity require hospitalization only if bleeding complications, including intracranial hemorrhage, occur.

If an intracranial hemorrhage is suggested or the patient has focal neurologic findings on examination, order a head CT scan without contrast to rule out an existing hemorrhage.

If hemorrhage is present, the patient should receive inpatient medical management, with a neurosurgeon consulted for possible drainage of the fluid collection.

Patients who present with other forms of bleeding should receive vitamin K and should be observed until they are stable, with follow-up evaluation provided on an outpatient basis.

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Further Outpatient Care

Patients with vitamin E toxicity who are stable can be treated in an outpatient setting, with periodic monitoring of the PT to ensure its return to normal levels if bleeding develops.

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Deterrence/Prevention

Individuals can avoid vitamin E toxicity by adhering to the daily recommended dosages of the vitamin and through monitoring of PT when anticoagulants are being taken.

Patients with nutritional deficiency should increase their intake of vitamin K to prevent bleeding complications.

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Prognosis

In most patients with vitamin E toxicity, the prognosis is excellent once the supplements are discontinued.

Patients with mild bleeding episodes are likely to fully recover once vitamin K is administered and the vitamin E supplements are discontinued.

Patients with intracranial hemorrhage have an increased mortality rate; however, with proper diagnosis and management, many patients with this condition survive and recover some or all of their previous functions.

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Patient Education

If a patient is taking vitamin E while on oral anticoagulants, inform the patient of the possible adverse bleeding effects and recommend limiting vitamin E intake to the RDA (15 mg/d).

Inform patients taking high doses of vitamin E (400 IU or more) that no compelling evidence exists that vitamin E reduces cardiovascular risk or cancer and that it may increase heart failure and mortality, especially in patients with chronic diseases.[23, 24]

Inform patients taking lipid-lowering agents that vitamin E may blunt the beneficial effect on HDL.

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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 Grant/research funds Independent contractor; Genentech Grant/research funds Independent contractor

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.

Additional Contributors

We wish to thank Christy L Henry, MD, and Don S Schalch, MD, for their previous contributions to this article.

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