Problems When Patients Hide Supplements – Part 5

Part 5 of 7 parts.

Up to 60,000 cases of ingestion of toxic levels of vitamins occur annually, primarily in children who ingest the vitamins thinking they are candy. Cases are rarely fatal. Table 2 lists the known toxicities of vitamins.

Table 2. Vitamin Toxicity

Vitamin	Symptoms
A (Retinol)	Blurred vision in early stages of toxicity; acute toxicity can cause headache, photophobia, anorexia, nausea, vomiting, abdominal pain, drowsiness, irritability, seizures, and skin desquamation; chronic toxicity can cause erythema, eczema, pruritus, dry and cracked skin, cheilitis, conjunctivitis, palmar and plantar peeling, alopecia, and pain and tenderness in the bones of the extremities
B1 (Thiamine)	Tachycardia, hypotension, cardiac dysrhythmias, headache, anaphylaxis, vasodilation, weakness, and convulsions
B3 (Niacin)	Acute toxicity can cause prostaglandin-mediated symptoms (eg, flushing, wheezing, diarrhea); chronic toxicity can cause jaundice, abnormal liver function tests, and acanthosis
B6 (Pyridoxine)	Signs of sensory neuropathy (eg, paresthesias, ataxia, perioral numbness, impairment of position and vibration senses)
B2 (Riboflavin)	Yellow-orange urine
B5 (Pantothenic Acid)	Diarrhea
B9 (Folic Acid)	Gastrointestinal disorders, sleep problems, seizures; may interfere with some chemotherapy agents
C (Ascorbic Acid)	Renal colic, diarrhea, rebound scurvy in children of women taking high doses, glucose-6-phosphate dehydrogenase (G6PD)-associated hemolysis, dental decalcification, occult rectal bleeding, increased estrogen levels
D (Calciferol)	Acute toxicity can cause muscle weakness, apathy, headache, anorexia, irritability, nausea, vomiting, and bone pain; chronic toxicity can cause acute symptoms and constipation, anorexia, abdominal cramps, polydipsia, polyuria, backache, hyperlipidemia, and hypercalcemia
E (Tocopherol)	Acute toxicity can cause nausea, abdominal cramps, diarrhea, headache, fatigue, easy bruising and bleeding, diplopia, muscle weakness, creatinuria, and poor platelet agglutination
K (Phylloquinone)	Inhibits the effect of oral anticoagulants

Data from US Preventive Services Task Force.