International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Hypervitaminosis - An Emerging Pathological Condition J K Roop PG Department of Zoology, JC DAV College (Affiliated to Panjab University, Chandigarh), Dasuya-144205, District Hoshiarpur, Punjab, India ABSTRACT Vitamins are essential organic compounds that are required in small amounts to regulate various metabolic activities in the body. Prolonged and overconsumption of pharmaceutical forms of both water-soluble and fat-soluble vitamins may lead to toxicity and/or hypervitaminosis. Hypervitaminosis is an acute emerging pathological condition of the body due to excess accumulation of any of the vitamins. In case of acute poisoning with vitamin supplements/drugs, emergency assistance is required to detoxify the effects and restore the organization, structure and function of body’s tissues and organs. Sometimes death may occur due to intoxication to liver, kidney and heart. So, to manage any type of hypervitaminosis, proper diagnosis is essential to initiate eliminating the cause of its occurrence and accelerate the elimination of the supplement from the body. The present review discusses the symptoms of hypervitaminosis that seems to be a matter of concern today and management strategies to overcome toxicity or hypervitaminosis. Keywords: Hypervitaminosis, Toxicity, Vitamins, Vitamin pathology, Fat-soluble vitamin, Water- soluble vitamin. INTRODUCTION body, particularly in the liver. Vitamin B Vitamins are potent organic Complex and vitamin C are water- soluble. compounds present in small concentrations They are dissolved easily in food during in various fruits and vegetables. They cooking and a portion of these vitamins may regulate physiological functions and help in be destroyed by heating. They cannot be maintaining metabolic rate of the body. The stored in body and hence they have to be human body cannot synthesize vitamins on taken daily in foods. Any extra quantity its own. Therefore, it becomes essential to taken in one day is eliminated in urine as obtain right and sufficient vitamins through waste by the body. the diet in order to maintain healthy Presently, vitamins are made in lifestyle. Imbalanced and poor diet leads to different formulations by various deficiency of vitamins in the body. This pharmaceutical companies in the form of may bring about outburst of various syrups, tablets, pills and powders that are deficiency diseases which if untreated with readily available to be taken as supplements. adequate supplements may lead to death of Therapeutic use of vitamin supplements in an individual. Vitamins are broadly the form of vitamin therapy has helped categorized into, fat-soluble vitamins and people in fighting diseases and managing water-soluble vitamins. Vitamins A, D, E good health. Modern life style has created and K are fat-soluble vitamins. They are not an epidemic of binge drinking, missing lost by cooking and can be stored in the diets, irritability and indigestion. People are International Journal of Health Sciences & Research (www.ijhsr.org) 280 Vol.8; Issue: 10; October 2018 J K Roop. Hypervitaminosis - An Emerging Pathological Condition trying to integrate healthy habits into HYPERVITAMINOSIS already hectic schedule and to compensate Hypervitaminosis may be acute and for the loss of essential nutrients in the form chronic with very specific and general of vitamins, people have started taking clinical symptoms. Acute hypervitaminosis vitamin supplements daily, believing that in is the result of one time intake of very high case of increased concentration, excess of dose of one or multiple vitamin the vitamins will be lost independently from preparations/supplements. Chronic the body. This misconception and prolonged hypervitaminosis results due to gradual intake of vitamins may cause toxic effects in development of clinical symptoms by a the body or hypervitaminosis, although rare. latent course. Water-soluble and fat-soluble Hypervitaminosis is a condition reported of vitamin toxicity has their own specific having abnormally high storage levels of effects on the body leading to intoxication vitamins leading to toxic symptoms. syndrome. Certain symptoms of intoxication Generally toxicity and hypervitaminosis is syndrome are common to all the forms of caused by a large intake of highly fortified hypervitaminosis like headache, severe foods which leads to accumulation of fat- weakness, dizziness, inability to exercise, soluble vitamins in the liver. Natural foods inability to perform daily routine, nausea, have not been associated with any toxicity. sensations of internal tremor, constipation or [1,2] In the United States, the annual report diarrhoea. Hypervitaminosis due to fat- submitted by poison control centres reported soluble vitamin groups have a more that more than 60,000 people including pronounced course as these get accumulated children under the age of 6, were subjected in the body tissues and cause severe to life threatening outcomes due to vitamin intoxication. Hypervitaminosis due to toxicities. [3-5] The Dietary Reference Intake water-soluble vitamins has a less recommendations from the United States pronounced course and does not impose a Department of Agriculture define a threat to the life of a person. Therefore, it “tolerable upper intake level” for most of can be normalized by increasing the urinary the vitamins. [6] output and restricting the intake of such type Most of the natural fruits and of supplements. vegetables are considered to be the potent source of antioxidants instead of the HYPERVITAMINOSIS OF antioxidant supplements in the form of pills DIFFERENT VITAMIN TYPES and tablets. Studies reported that in the well- HYPERVITAMINOSIS A-- It nourished individuals, prolonged intake of occurs due to prolonged uncontrolled the antioxidant supplements including ingestion of too much of preformed vitamin vitamin A and vitamin E may cause increase A from foods (fish oil, animal liver and in mortality as a result of unwanted kidney, plant sources like carrots), consequences to the health. [7-9] Whereas, supplements in the form of pills/ tablets/ vitamin D3 supplements have been known powders or prescription medications. to decrease mortality in elderly people who Dietary vitamin A is available mainly as are living independently or in an preformed vitamin A in western countries institutional care. [10] It has been observed in and as provitamin A carotenoids in trials that regular intake of vitamin C developing countries. Vitamin A in supplements reduce the duration of cold but supplements per capsule is typically 10,000- this was not replicated when therapeutic 50,000 international units (IU). Fish-liver trials were conducted. Regular intake of oils may contain more than 180,000 IU/g. vitamin C supplements have not been The acute toxic dose of vitamin A is 25,000 reported to reduce the incidence of IU/kg, whereas the chronic toxic dose is occurrence of cold in general population. [11] 4000 IU/kg every day for 6-15 months. [12] GENERAL SYMPTOMS OF International Journal of Health Sciences & Research (www.ijhsr.org) 281 Vol.8; Issue: 10; October 2018 J K Roop. Hypervitaminosis - An Emerging Pathological Condition Hypervitaminosis A may be acute or intake of beta-carotene in men. [17] This can chronic. An acute form is extremely rare be reversed by discontinuing the intake of and the symptoms may express as headache, beta-carotene. Toxicity due to vitamin vomiting, short-term loss of consciousness, supplements has also been reported in dizziness, irritability, nausea, abdominal children. [18] pain, fever, skin rashes without clear Management is by discontinuation of localization all over the body and visual supplements and taking prescribed disturbances like diplopia. The chronic recommended dose. If mental changes are forms are associated with the symptoms like reported, hospitalization is required. Once dry patchy skin, dry fissured lips, hair loss identified, the prognosis is good. Mortality and brittle nails. It affects the osteoarticular is rare. Yellow colour of skin gets reversed apparatus by altering bone metabolism with time. accompanied by stiffness in movements, HYPERVITAMINOSIS D-- It is caused by pain and swelling of periarticular soft prolonged and/or excessive intake of tissues. It is also accompanied by anorexia prescribed medications such as calcium (over eating may result in irreversible health along with vitamin D. Excessive exposure complications including death), alopecia to sunlight does not result in excessive (baldness), weight loss, low grade fever, levels of vitamin D. Today people tend to hepatosplenomegaly, papilloedema (optic stay indoors and this concern about vitamin disc swelling caused by increased D deficiency that has led to the intracranial pressure due to any cause), increased/over consumption of various pseudotumor cerebri (caused by increased forms of vitamin D supplements. The acute pressure around the brain).Other features toxic dose for vitamin D has not been include complications like reported. The chronic toxic dose in adults is hypercholesterolemia and atherosclerotic higher than 50,000 IU/day. In infants disease, anemia and thrombocytopenia (in younger than 6 months, 1000 IU/day may be infants), [13] hypocalcaemia, hypercalciuria considered unsafe. The tolerable upper and renal stones, benign intracranial intake level (UL) for all groups > 1 year is hypertension and increased production of 2000IU/day. [19] Therefore, there is wide mineralocorticoids