eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin E Toxicity: Follow-up

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

Follow-up

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.

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • A medical and/or legal problem could arise if a patient develops a significant bleeding complication as a result of a physician-prescribed combination of oral anticoagulants and vitamin E without warning the patient of the increased risk of bleeding and elevated INR.
  • If a patient is taking vitamin E while on oral anticoagulants, warn the patient of the possible adverse bleeding effects and recommend limiting vitamin E intake to the RDA (15 mg/d).
  • Warn 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.
  • Warn patients taking lipid-lowering agents that vitamin E may blunt the beneficial effect on HDL.
 
Acknowledgments

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



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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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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