Vitamin Toxicity Treatment & Management

  • Author: Mark Rosenbloom, MD, MBA, FAAEM; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Feb 2, 2011
 

Emergency Department Care

All ingestions require supportive management and an intravenous line. Serious ingestions require hydration if vomiting or diarrhea is present. Oxygen, monitoring, and ABCs are essential if potential life-threats are present. If potentially lethal co-ingestions are present, perform gastric lavage if the patient presents within 1 hour postingestion. Other care is symptomatic and supportive.

Vitamin A

Symptoms usually resolve after stopping vitamin A and instituting supportive therapy.

Increased ICP may require daily therapeutic LPs or further increased ICP treatment (diuretics, mannitol).

Symptomatic hypercalcemic patients may require fluids or electrolyte correction.

Vitamin D

Place patients with vitamin D toxicity on a low-calcium diet.

Consider calcium disodium edetate orally to increase fecal excretion of calcium.

In severe hypercalcemia, patients may require hydration, diuretics, steroids (hydrocortisone 100 mg IV q6h), calcitonin (4-8 IU/kg q6-12h), and/or mithramycin (25 mcg/kg qd IV over 4-6 h for 1-4 d). Peritoneal or hemodialysis may be necessary if large amounts of fluids cannot be given.

Vitamins E, K, B-1, B-2, B-6, B-12, and C, and folate

These usually require only supportive measures.

Vitamin B-3 (ie, niacin)

Provide supportive treatment as needed.

Aspirin taken 30 minutes before niacin decreases the flush response.

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Consultations

Consult the regional poison control center or a local medical toxicologist (certified through the American Board of Medical Toxicology or the American Board of Emergency Medicine) for additional information and patient care recommendations.

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Contributor Information and Disclosures
Author

Mark Rosenbloom, MD, MBA, FAAEM  Fellow of the American Academy of Emergency Medicine; Overseas Fellow of the Royal Society of Medicine; Chief Executive Officer and Editiorial Director, PEPID, LLC; Founder and Chairman, The Unicorn Children's Foundation

Mark Rosenbloom, MD, MBA, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Lavely, MD, JD, MS, MPH  Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  15. Med Lett Drugs Ther. Toxic effects of vitamin overdosage. Med Lett Drugs Ther. Aug 3 1984;26(667):73-4. [Medline].

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

  17. 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.

  18. Sachter JJ. Vitamins. In: Handbook of Medical Toxicology. Little Brown & Co Inc; 1993:399-402.

 
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