eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Vitamin: Follow-up
Updated: Apr 20, 2009
Follow-up
Further Inpatient Care
- Admit patients with the following conditions:
- Risk for suicide
- Intractable emesis
- Altered mental status
- Neurologic symptoms
- Serious co-ingestions
- Severe dehydration
- Metabolic derangements (eg, hypercalcemia, severe electrolyte abnormalities, ECG changes, renal or liver damage)
Complications
- For complications of vitamin toxicity, see Physical.
Prognosis
- The prognosis is generally excellent. According to the American Association of Poison Control Centers' National Poison Data System, in 2007, more than 58,000 acute or chronic vitamin overdoses were documented, with 17 major adverse outcomes and 1 death.3
Patient Education
- Remind parents of children who ingested vitamins of the appropriate ways to childproof their homes and emphasize the need to use child-resistant bottles.
- Instruct adults who have unintentionally overdosed on vitamins as part of their megavitamin regimen on the serious adverse effects of such chemicals.
- For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Iron Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.
Miscellaneous
Medicolegal Pitfalls
- Failure to identify other potentially lethal co-ingestants, such as acetaminophen, aspirin, and dangerous prescription drugs (ie, digoxin, lithium, phenothiazines)
- Failure to always check if the vitamin overdose included iron supplements and failure to manage such an overdose aggressively
- Failure to be wary of large or chronic ingestions of all vitamins in children, especially the fat-soluble vitamins A and D
- Failure to note that vitamin K is dangerous in neonates
- Failure to abstain from administering vitamin C to anyone with G-6-PD deficiency (hemolysis)
- Failure to note that vitamin A potentially is very teratogenic in pregnancy
- Failure to note that folic acid may mask pernicious anemia
- Failure to include vitamin A toxicity in patients who present with headaches
More on Toxicity, Vitamin |
| Overview: Toxicity, Vitamin |
| Differential Diagnoses & Workup: Toxicity, Vitamin |
| Treatment & Medication: Toxicity, Vitamin |
 Follow-up: Toxicity, Vitamin |
| References |
| « Previous Page |
References
North America, Asia lead vitamin and supplement usage. Nielsen Wire. Available at http://blog.nielsen.com/nielsenwire/consumer/north-america-asia-lead-vitamin-and-supplement-usage/. Accessed March 20, 2009.
Griffin RM, Hoffman H. Live well vitamins & supplements center. WebMD. Available at http://gnc.webmd.com/vitamin-facts. Accessed March 22, 2009.
Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline]. [Full Text].
Dietary Supplement Fact Sheet: Vitamin A and Carotenoids. National Institutes of Health - Office of Dietary Supplements. Available at http://ods.od.nih.gov/factsheets/vitamina.asp. Accessed July 5, 2007.
Pazirandeh S, Burns DL. Overview of vitamin A. UpToDate. Available at www.uptodate.com. Accessed July 5, 2007.
Bakerman S. ABC's of Interpretive Laboratory Data. 4th ed. Scottsdale, AZ: Interpretive Laboratory Data, Inc; 2002.
Brody JE. In vitamin mania, millions take a gamble on health. In: New York Times. October 26, 1997:1, 20.
Cristoph RA. Vitamins. In: Manual of Toxicologic Emergencies. Year Book Medical Publishers; 1989:490-5.
Dietary Supplement Fact Sheet: Vitamin E. National Institutes of Health - Office of Dietary Supplements. Available at http://ods.od.nih.gov/factsheets/vitamine.asp. Accessed March 20, 2009.
Fischbach F. A Manual of Laboratory and Diagnostic Tests. 7th ed. Lippincott Williams & Wilkins; 2004.
Food and Nutrition Board. Recommended Dietary Allowances. 10th ed. National Academy Press: Washington, DC; 1989.
Goldfrank L, Lewis R. Vitamins. In: Goldfrank's Toxicologic Emergencies. 5th ed. Prentice Hall; 1994:535-44.
Hathcock JN. Vitamins and minerals: efficacy and safety. Am J Clin Nutr. Aug 1997;66(2):427-37. [Medline].
Hoffman RS. Thiamine hydrochloride. In: Goldfrank L, ed. Goldfrank's Toxicologic Emergencies. 5th ed. New York: Prentice Hall; 1997:825-6.
Med Lett Drugs Ther. Toxic effects of vitamin overdosage. Med Lett Drugs Ther. Aug 3 1984;26(667):73-4. [Medline].
Meyers DG, Maloley PA, Weeks D. Safety of antioxidant vitamins. Arch Intern Med. May 13 1996;156(9):925-35. [Medline].
NIH Clinical Center. Vitamin E. National Institutes of Health - Office of Dietary Supplements. Available at http://ods.od.nih.gov/factsheets/vitamine.asp. Accessed July 5, 2007.
Sachter JJ. Vitamins. In: Handbook of Medical Toxicology. Little Brown & Co Inc; 1993:399-402.
Further Reading
Keywords
vitamin A, retinol, vitamin D, cholecalciferol, vitamin E, alpha-tocopherol, vitamin K, phytonadione, vitamin B-1, thiamine, vitamin B-2, riboflavin, vitamin B-3, niacin, vitamin B-6, pyridoxine, vitamin B-12, cyanocobalamin, vitamin C, ascorbic acid, folic acid, B complex vitamins, nicotinic acid, beta-carotene, provitamin A, vitamin K-3, menadione, vitamin toxicity, iron-containing vitamins, fat-soluble vitamins, multiple vitamins, acute vitamin overdose, chronic vitamin overdose, craniotabes, bulging fontanelle, osteoporosis, angular cheilitis, alopecia, epiphyseal capping, premature epiphyseal closure, frontal headache, blurred vision, papilledema, hepatomegaly, ascites, erythematous dermatitis, migratory arthritis, increased bone resorption, bone pain, calcinosis, hypercalcemia, jaundice, hemolytic anemia, hyperbilirubinemia, sensory neuropathies, burning pains, paresthesias, ataxia, paralysis, perioral numbness, sensory ataxias, nephrolithiasis, renal colic, occult rectal bleeding, dental decalcification, diminished tendon reflexes, impairment of position sense, impairment of vibration sense
