HistoryBe wary of large or chronic ingestions of all vitamins in children, especially the fat-soluble vitamins A and D. Nonspecific symptoms, such as nausea, vomiting, diarrhea, and rash, are common with any acute or chronic vitamin overdose. Vitamin-related symptoms may be secondary to those associated with additives (eg, mannitol), colorings, or binders; these symptoms usually are not severe. Vitamin AIn acute vitamin A toxicity, a history of some or all of the following may be present:
Do not forget to evaluate for ingestion of other potentially toxic substances, such as other vitamins, aspirin, and acetaminophen. Inquire about the intake of other supplements and evaluate for possible overdose accordingly. As previously discussed, isotretinoin (Accutane), a drug used for the treatment of severe forms of acne, is closely related to the chemical structure of vitamin A and therefore has similar pharmacologic and toxic attributes. A careful drug history to uncover possible isotretinoin use is important in patients presenting with manifestations suggestive of vitamin A intoxication. Vitamin CThe effects of vitamin C toxicity can include the following:
Vitamin EIt is likely that patients with vitamin E toxicity have been using vitamin E supplements; obtain the dose and duration of vitamin E usage. Assess concurrent use of anticoagulants or aspirin. A nutritional assessment for vitamin K deficiency is useful in patients who present with bleeding or an elevated PT. The effects of acute vitamin E toxicity include the following:
Vitamin KVitamin K toxicity is typically associated with formula-fed infants or those receiving synthetic vitamin K-3 (menadione) injections. Because of its toxicity, menadione is no longer used for treatment of vitamin K deficiency. The effects of vitamin K toxicity can include jaundice in newborns, hemolytic anemia, and hyperbilirubinemia. Toxicity also blocks the effects of oral anticoagulants.
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