Vitamin Toxicity Workup

Author: Mark Rosenbloom, MD, MBA, FAAEM; Chief Editor: Asim Tarabar, MD more...

Updated: Feb 2, 2011

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
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Laboratory Studies

Acetaminophen and aspirin levels should be assessed in every suspected ingestion. Electrolyte levels must be assessed in patients with severe vomiting or diarrhea.

Vitamin A

Retinol: Reference range is 20-60 mcg/dL. A toxic vitamin A level is higher than 60-100 mcg/dL. Obtain a CBC to rule out leukopenia. Perform calcium, glucose, and liver function tests (LFTs). Levels are affected by liver stores and dietary intake of vitamin A.
Serum carotene: Normal range is 50-300 mcg/dL. Reflects dietary intake of vitamin A.

Vitamin D

Obtaining calcium levels is mandatory; they are usually above 11 mg/dL but may be much higher. Phosphate levels may increase with calcium.

Renal function tests (ie, BUN, creatine, urinalysis [UA]) are necessary to rule out possible kidney damage from hypercalciuria.

Vitamin E

Measure PT, aPTT, and bleeding times, especially if any evidence of bruising or bleeding is present. Platelet aggregation studies may be performed if bleeding time results are abnormal.

Vitamin K

Measure PT if the patient is taking oral anticoagulants.

Vitamins B-1, B-2, and B-12

These require no specific laboratory tests.

Vitamin B-3 (ie, niacin)

Perform LFTs. Uric acid may be increased, leading to gouty arthritis. Glucose level is occasionally elevated.

Vitamin B-6

Vitamin B-6 toxicity does not require laboratory or other tests.

Lumbar puncture (LP) may be considered to rule out other causes if the patient has a peripheral neuropathy.

Vitamin C

Perform UAs to rule out uricosuria. False-negative test results for glucosuria are possible.

Perform renal function tests. Measure PT if the patient is taking warfarin (Coumadin); vitamin C may interfere with Coumadin.

Measure serum iron levels because vitamin C also enhances the absorption of iron.

Obtain skeletal radiographs to look for calcifications in chronic vitamin A and vitamin D toxicity.
Obtain a helical CT scan or an intravenous urogram (IVU) for suspected nephrolithiasis (ie, oxalate stones) in patients with vitamin C toxicity.
A kidneys, ureters, bladder (KUB) film is indicated for suspected toxicity from iron-containing pills.

Obtain an ECG to evaluate for effects of hypercalcemia in patients with vitamin D toxicity.

An LP may be indicated to rule out increased intracranial pressure (ICP) in patients with vitamin A toxicity.

Proceed to Treatment & Management

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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Griffin RM, Hoffman H. Live well vitamins & supplements center. WebMD. Available at http://gnc.webmd.com/vitamin-facts. Accessed March 22, 2009.
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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.
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