Background
Every day 44% of Americans take vitamins and dietary supplements.[1] In 2007, vitamin C, vitamin E, and multivitamins were among 5 best-selling supplements.[2] As many as 84% of Americans consider vitamins and supplements safe,[2] thus, increasing the risk for vitamin toxicity. Iron-containing vitamins are the most toxic, especially in pediatric acute ingestions (see Toxicity, Iron). Fat-soluble vitamins have higher potential for toxicity due to their capability to accumulate in the body.
Epidemiology
Frequency
United States
The 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System document the total number of exposures for each class of vitamins, the number of patients with major adverse outcomes, and the number of fatalities from that ingestion,[3] as follows:
- Adult multiple vitamins without iron or fluoride - 3,100 total exposures, 0 major outcomes, and 0 deaths
- Adult multiple vitamins with iron but without fluoride - 6416 total exposures, 0 major outcomes, and 0 deaths
- Pediatric multiple vitamins without iron or fluoride - 23,141 total exposures, 0 major outcomes, and 0 deaths
- Pediatric multiple vitamins with iron but without fluoride -13,036 total exposures, 2 major outcome, and 0 deaths
- Vitamin A - 637 total exposures, 0 major outcomes, and 0 deaths
- Niacin - 2,495 total exposures, 2 major outcomes, and 0 deaths
- Pyridoxine - 232 total exposures, 0 major outcomes, and 0 deaths
- Other B complex vitamins - 3011 total exposures, 1 major outcomes, and 0 deaths
- Vitamin C - 1,546 total exposures, 0 major outcomes, and 0 deaths
- Vitamin D - 1221 total exposures, 0 major outcome, and 0 deaths
- Vitamin E - 772 total exposures, 0 major outcome, and 0 deaths
- Overall, 60,719 exposures to different types of vitamins were reported to the poison control centers across the United States in 2008, accounting for 8 major adverse outcomes and 0 deaths. Of the total exposures, 46,550 incidents occurred in children younger than 6 years old and 8,255 involved individuals aged 6-19 years.
Mortality/Morbidity
Morbidity and mortality from pure vitamins are rare. According to the American Association of Poison Control Centers' National Poison Data System, in 2008, more than 60,000 acute or chronic vitamin overdoses were documented, with 8 major adverse outcomes and 0 deaths.[3]
Race
No scientific data indicate that outcomes of vitamin overdose are dependent on race.
Sex
No scientific data indicate that outcomes of vitamin overdose are dependent on sex.
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, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].
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.
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