Vitamin overdose | |
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Classification and external resources | |
ICD-10 | E67.0-E67.3 |
ICD-9 | 278.2, 278.4 |
Hypervitaminosis refers to a condition of high storage levels of vitamins, which can lead to toxic symptoms. The medical names of the different conditions are derived from the vitamin involved: an excess of vitamin A, for example, is called hypervitaminosis A.
Generally, toxic levels of vitamins are achieved through high supplement intake and not from dietary sources. Toxicities of fat-soluble vitamins result also can be caused by a large intake of highly fortified foods, but foods rarely deliver dangerous levels of fat-soluble vitamins.[1]
The Dietary Reference Intake recommendations from the United States Department of Agriculture define a "tolerable upper intake level" for most vitamins.
High dosage vitamin A; high dosage, slow release vitamin B3; and very high dosage vitamin B6 alone (i.e. without vitamin B complex) are sometimes associated with vitamin side effects that usually rapidly cease with supplement reduction or cessation.
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Fat soluble
With few exceptions, like some vitamins from B complex, hypervitaminosis usually occurs more with fat-soluble vitamins, which are stored in the liver and fatty tissues of the body. These vitamins build up and remain for a longer time in the body than water soluble vitamins.[1]
Conditions include:
Water soluble
Vitamin C has a brief, pronounced laxative effect when taken in large amounts. This effect can be lessened by taking the large amount 5-10 grams per day in divided (smaller) doses.
Vitamin B6 excess can be mitigated by taking a low-dose B6 supplement together with a B-complex (which normally also contains B6), or with food rich in B vitamins, e.g., cereals.
Minerals
High doses of mineral supplements can also lead to side effects and toxicity. Mineral-supplement poisoning does occur occasionally, most often due to excessive intake of iron-containing supplements.
Comparative safety statistics
Death by vitamin poisoning appears to be quite uncommon in the US, typically none in a given year.[2] For example, in the United States, overdose exposure to all formulations of "vitamins" was reported by 62,562 individuals in 2004 (nearly 80%(~78%, n=48,989) of these exposures were in children under the age of 6), leading to 53 "major" life-threatening outcomes and 3 deaths(2 from Vitamins - D and E; 1 from polyvitaminic type formula, with iron and no fluoride).[3] This may be compared to the 19,250 people who died of unintentional poisoning of all kinds in the U.S. in the same year (2004).[4] In 2007, 58,000 exposures to various vitamins and multivitamin-mineral formulations were reported to poison control centers, which resulted in 17 severe reactions and 1 death.[5] In 2008 there were no deaths reported from vitamin overdose,[6] as has been the case for 17 of the last 25 reporting-years.[7]
Before 1998, several deaths per year were associated with pharmaceutical iron-containing supplements, especially brightly-colored, sugar-coated, high-potency iron supplements, and most deaths were children.[8] Unit packaging restrictions on supplements with more than 30 mg of iron have since reduced deaths to 0 or 1 per year.[8] These statistics compare with 59 confirmed deaths due to aspirin poisoning in 2003 [9] and 147 deaths known to be associated with acetaminophen-containing products in 2003.[9]
See also
References
- ^ a b Sizer, Frances Sienkiewicz; Ellie Whitney (2008). Nutrition: Concepts and Controversies (11 ed.). United States of America: Thomson Wadsworth. pp. 221, 235. ISBN 0495390658.
- ^ http://www.orthomolecular.org/resources/omns/v05n04.shtml
- ^ 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.
- ^ National Center for Health Statistics
- ^ 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.
- ^ Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clinical Toxicology (2009). 47, 911-1084. The full text article is available for free download at [1]. Vitamins statistics are found in Table 22B, journal pages 1052-3. Minerals, herbs, amino acids and other supplements are in the same table, pages 1047-8
- ^ [2] Vitamin overdose: where are the bodies?
- ^ a b Tenenbein M (2005). "Unit-dose packaging of iron supplements and reduction of iron poisoning in young children". Arch Pediatr Adolesc Med 159 (6): 557–60. doi:10.1001/archpedi.159.6.557. PMID 15939855. http://archpedi.ama-assn.org/cgi/content/full/159/6/557.
- ^ a b Watson WA, Litovitz TL, Klein-Schwartz W, et al. (2004). "2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System". Am J Emerg Med 22 (5): 335–404. doi:10.1016/j.ajem.2004.06.001. PMID 15490384. http://linkinghub.elsevier.com/retrieve/pii/S073567570400141X.
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