Hypervitaminosis is an urgent acute emerging pathological state of the body, provoked by the toxic effect of increased concentration of a particular vitamin.
Vitamins and vitamin-like nutrients are organic compounds that ensure the health of all living beings, therefore, each person tries to consume them in sufficient quantities through food or artificially, through the use of pharmaceutical medications.
At the present time there is a significant increase in the incidence of hypervitaminosis and this fact is explained by the free sale of vitaminized preparations and biological supplements containing vitamin-like substances in pharmacy chains. Most people take uncontrolled, increased doses of medicines containing vitamins, believing that in case of increased concentration, excess vitamins will be released independently from the body. This common misconception leads to the emergence of hypervitaminosis in a broad category of patients.
This nosological unit should be considered as one of the forms of poisoning of the body, since with the excessive intake of vitamin-like substances in the human body these useful substances have toxic effects.
Causes of hypervitaminosis
All groups of vitamins are divided into two large categories - water-soluble and fat-soluble. Excess concentration of water-soluble vitamins is extremely rare, only in the case of a heavy overdose of injectable vitaminized preparations, since the necessary amount of vitamin is absorbed into the blood, and the rest is quickly excreted in the urine. Elimination of fat-soluble vitamins is much more difficult, because in addition to being absorbed into the blood, this group of vitamins accumulates in adipose tissues of various organs.
Undoubtedly, the main cause of hypervitaminosis is the intoxication of the body with synthetic forms of vitamins and vitamin-like substances, but in some cases, poisoning with vitamins can occur even if they come in a small amount, subject to individual intolerance of a vitamin medication.
In addition, it contributes to the development of hypervitaminosis of one or a whole group of vitamins, the use of the same type of diet with excessive consumption of foods that have a high concentration of a particular vitamin.
In addition to complications caused by a direct toxic effect of increased vitamin concentrations, the risk of hypervitaminosis is the risk of developing a deficiency of minerals beneficial to the body. As a result of the destruction of a large number of vitamins, the body accumulates by-products of their metabolism, which provoke various metabolic disorders.
Symptoms of hypervitaminosis
All manifestations of hypervitaminosis can have acute and sometimes chronic course, each of which is characterized by specific and general clinical symptoms. Of course, the symptoms of hypervitaminosis can occur with an overdose of any complex of multivitamins, but more often in pediatric and therapeutic practice, there are cases of excessive accumulation in the patient's body of a fat-soluble vitamin group.
The acute form of hypervitaminosis develops in a situation of a one-time intake of several times increased daily dose of one or several vitamin preparations, and therefore, the clinical manifestation of hypervitaminosis is similar to an intoxication syndrome. Chronic form of hypervitaminosis is characterized by a latent course and gradual development of the clinical symptom complex, in connection with which, the diagnosis of hypervitaminosis becomes extremely difficult.
In connection with the fact that each group of vitamins has its own sphere of influence and affects the functioning of various structures of the human body, the manifestations of their excessive content with each form of hypervitaminosis also have specific features. And at the same time, for each form of hypervitaminosis, the development of symptoms of intoxication syndrome (the appearance of headache, dizziness, severe weakness and inability to perform daily routine physical activities, nausea, sensations of internal tremor and upset of the stool) is inherent in each form of hypervitaminosis.
It should be borne in mind that hypervitaminoses of fat-soluble vitamin groups have a more severe course, due to their ability to be cumulated in the body and provoke severe intoxication. Hypervitaminoses of water-soluble vitamin groups are characterized by a less aggressive course and do not cause a prolonged disorder of the patient's health, therefore, as a medical intervention of this type of poisoning, it is sufficient to stop the intake of the vitaminized drug into the body and stimulate the urinary function of the kidneys, as this category of vitamins is quickly excreted urine.
Hypervitaminosis of group A occurs with prolonged uncontrolled use of its dosage form in an increased daily dose (in adults more than 500,000 IU, in children more than 100,000 IU for half a year) and manifests itself in the form of dry skin with the presence of maceration areas, hair loss and excessive brittle nails. With regard to the effect on the osteoarticular apparatus, hypervitaminosis A is manifested by the appearance of painful seals in the soft tissues due to the development of periostitis in the projection of the tubular bones, as well as the development of arthropathies of different localization, accompanied by stiffness in movements, pain and swelling of periarticular soft tissues.
In connection with the fact that vitamin A takes an indirect part in the processes of lipid metabolism, its increased content in the body inevitably leads to hypercholesterolemia , manifested as signs of atherosclerotic disease. The prolonged course of hypervitaminosis A is accompanied by an increase in the production of mineralocorticoids by the adrenal glands, as a result of which the patient can have generalized edematous syndrome.
Severe effects of hypervitaminosis group A have among pregnant women, since long-term use of this drug provokes the development of congenital anomalies in the fetus. The acute form of hypervitaminosis A is extremely rare and manifests itself as symptoms of increased intracranial pressure ( headache , indomitable vomiting, short-term loss of consciousness), fever and skin rashes that do not have a clear localization.
Elderly persons are prone to the following signs of hypervitaminosis type A: exacerbation of all chronic pathologies, common arthralgia, decreased vision, imbalance of lipidogram indices, various forms of arrhythmia, symptoms of chronic hepatic renal failure.
Hypervitaminosis of group D is provoked by the use of shock saturated rickets, and also as a result of treatment of dermatosis , in which the applied dosage of Calciferol exceeds 1,000,000 IU.
Signs of hypervitaminosis D in adults consist in the appearance of weakness, rapid fatigue, subfebrile type of fever, the phenomena of functional dyspepsia, accompanied by progressive weight loss. The patient is worried about constant headaches that do not have a clear localization, a tendency to hypertensive crises .
Signs of acute poisoning with vitamin D preparations are the appearance of tremors of the hands, a sharp pain syndrome in the muscular massif of the back and extremities, subcutaneous hemorrhages of various forms and extent, as well as signs of general dehydration of the body.
In a laboratory study of blood and urine, a high calcium content is found in this situation. In the case of chronic intoxication of the body with vitamin D preparations in a minimal dosage, the person develops a tendency to form calcifications in various structures and organs (vessels, soft tissues, pulmonary parenchyma), but the greatest danger is assumed by calcification of the kidneys, since they can cause chronic renal failure . An interesting fact is that in case of chronic hypervitaminosis, D calcium is washed out of the bone tissue, which is confirmed during X-ray examination, and simultaneously accumulates in periarticular soft tissues, provoking the development of signs of deforming arthrosis and bursitis .
In the elderly, hypervitaminosis D promotes the development of various forms of cardiomyopathies in combination with bradyarrhythmic disorders of cardiac activity, generalized icterus of the skin and mucous membranes, muscle weakness and tremor of the distal parts of the extremities, as well as arthralgia of various localization. When there are signs of hypervitaminosis in group D, the risk of anomalies in the development of bone structures increases dramatically in pregnant women.
Due to the fact that vitamin E accumulates quickly enough in the body and is difficult to break down, excessive use of pharmaceutical concentrates inevitably leads to the development of its excess content.
Hypervitaminosis E is manifested by nonspecific clinical symptoms, so the diagnosis is possible only in the case of available information on the long-term use of dosage forms of this drug. The patient in this situation may be concerned with headaches, disability, diarrhea . In addition, hypervitaminosis E provokes the development of vitamin A and D deficiency, since vitamin E disrupts the absorption of other fat-soluble vitamins in the intestine.
Hypervitaminosis of group C is perhaps the most common form of this pathology, as everyone knows about the beneficial properties of this vitamin and does not hesitate to take synthetic analogues of it, do not control the dose of the drug.
The appearance of hypervitaminosis C has a particularly unfavorable effect on the health of persons suffering from a predisposition to kidney stone formation, as the excessive content of vitamin C in the body provokes the accumulation of oxalates and their deposition in the renal parenchyma and gall bladder. In addition, the symptoms of hypervitaminosis C in the adult category of patients is progressive deterioration of vision, insomnia, dysmenorrhea, hormonal disorders.
Hypervitaminosis of vitamins of group B most often has a combined character, in this connection for all its types typical clinical symptoms appear in the form of generalized hyperemia and hypersensitivity of skin, headache of varying degrees of intensity without limited localization, the occurrence of sleep disorders, increased convulsive readiness .
Hypervitaminosis of vitamin B12 is most often observed in the elderly who take oral or parenteral dosage form for the treatment of malignant anemia.
Hypervitaminosis of vitamin B6 is extremely rare, as for its development the dose of the drug should exceed more than 1000 times. The main sign of excess vitamin B6 in the body is the appearance of symptoms of progressive polyneuropathy (aching pain and paresthesia along the vascular-neural bundle in the lower and upper extremities, violation of all sensitivities). The leveling of these symptoms after stopping the medication is only for two months.
Hypervitaminosis of B2 group is most often manifested in the appearance of signs of liver dysfunction, photophobia, zaed in the corners of the mouth and cardiomyopathies.
A specific symptom of hypervitaminosis B9 is tonic convulsions in the gastrocnemius muscles that occur at any time of the day without the existing organic pathology.
Hypervitaminosis of the group of PP vitamins, as a rule, is characterized by acute course and a rapid increase in the intensity of clinical symptoms. The patient in this situation complains of the acute nausea and diarrhea that is not associated with eating. When visual inspection of the patient marked reddening of the skin of a diffuse nature, the occurrence of which is due to a sharp expansion of the subcutaneous capillary arterial network.
The target organ, which is affected in 90% of cases with existing PP hypervitaminosis, is a thin intestinal tract, so patients with an excessive content of this group of vitamins tend to develop signs of dysbiosis with severe course.
Hypervitaminosis in children
In the children's category of patients, hypervitaminosis of any type is more severe than in adults, because hormonal and enzymatic reactions are imperfect in children, and intoxication syndrome aggravates the course of the underlying disease. The peculiarity of hypervitaminosis in children is that the provocation of their occurrence can be not only the use of synthetic drugs containing this or that vitamin, but also the excessive use of foods with a high content. In this regard, special attention should be paid to balancing the nutrition of the child and with care to introduce products as the first complementary foods.
Hypervitaminosis of group A in children occurs in extremely severe form, and clinical symptoms are a manifestation of the defeat of almost all organs and systems. With excess vitamin A in the child's body, the following changes are observed: a sharp throbbing headache in the temporal region, a double vision before the eyes, a complete lack of appetite, dryness of the mucous membranes of the nasal, oral cavity and conjunctiva of the eyes. Children suffering from hypervitaminosis type A, are highly irritable, crying, drowsy. Signs of congenital hypervitaminosis A, which is a consequence of the use of synthetic carotene by the mother during pregnancy, can become severe congenital malformations of the heart, facial part of the skull and thymus gland.
Hypervitaminosis D in pediatric practice occurs quite often in a situation where a healthy, full-term child instead of a preventive dose is used for a long time with a therapeutic saturating dose of vitamin D. Signs of intoxication in this case is the appearance of a child's feelings of aversion to food and persistent vomiting, a disorder of stools in the form of a tendency to diarrhea , a constant sense of thirst. In the case of continuing intoxication, the child develops general dehydration of the body, resulting in significant weight loss, hypertension , lag in physical development, excitement. Severe form of this type of hypervitaminosis is accompanied by respiratory and hemodynamic disorders, a violation of consciousness of different depths, increased convulsive readiness, signs of acute renal failure. Laboratory confirmation of hypervitaminosis D is the excretion of a large amount of calcium and phosphorus in the urine.
The use of large doses of vitamin K is extremely difficult for the child because of the massive destruction of erythrocytes in the body, which in a short time provokes the development of a lethal outcome.
The excessive content of vitamin B in the body of the child most often causes the development of an allergic reaction of varying severity and duration. It should be borne in mind that vitamins of this group are able to neutralize the antimicrobial effect of anti-tuberculosis drugs, therefore synthetic analogues of these groups should be cautiously prescribed to patients suffering from this or that form of the tuberculosis process.
Treatment of hypervitaminosis
The initial stage of treatment for any type of hypervitaminosis is to eliminate the cause of its occurrence and accelerate the elimination of the drug. In some cases, a sufficient measure is the withdrawal of the drug and the restriction of food products containing a high concentration of a particular vitamin. So, for example, with hypervitaminosis A it is necessary to exclude from the diet for a while products of milk origin, in particular butter.
Before starting treatment of a patient with all clinical signs of hypervitaminosis, a careful laboratory analysis of the contents of a particular group of vitamins in the blood plasma should be carried out in order to select a rational diet and restrict the use of certain categories of products.
The appearance in the child of signs of acute hypervitaminosis D is justification for the use of glucocorticosteroid drugs (Dexamethasone 4 mg intramuscularly) in combination with synthetic vitamins of group A, C, B, which have antitoxic action against vitamin D (Vitamin A in a daily dose of 5000 IU, ascorbic acid in a daily dose of 0.05 g).
In order to avoid the appearance of signs of hypervitaminosis, experts recommend not using pharmaceutical forms of vitamins without first consulting dieticians and gastroenterologists.
The emergence of signs of acute hypervitaminosis in patients of different age category is the justification for hospitalization with the purpose of carrying out emergency measures and further treatment. Emergency assistance consists in the use of detoxification measures, measures to restore lost functions of vital structures and organs, and eliminate violations of mineral metabolism.
In a situation where acute hypervitaminosis of any type has occurred as a result of a single use of an ultra-high dose of a vitamin preparation, it is necessary to rinse the upper sections of the gastrointestinal tract with a probe method. If, after taking the medication, a sufficient amount of time has passed and the patient has signs of acute intoxication, it is advisable to apply infusion therapy using first colloidal solutions (400 ml Rheopoliglykin intravenously drip), then crystalloids (0.9% isotonic sodium chloride solution at a dose of up to 2 l intravenously drip). In pediatrics, the required volume of infusion solutions is determined by the calculation methods: 150 ml of the solution are necessary for 1 kg of the child's body weight, 80% of which must be the parenteral type of administration, and the rest volume should be administered orally (Regidron 10 ml per 1 kg of the patient's weight).
In a situation where the patient is accompanied by signs of neurotoxicosis to the general clinical symptoms, dehydration measures (Furosemide at a daily dose of 0.5 mg per kg of patient weight intravenously) should be used. As measures to eliminate the existing acidosis , oxygen therapy with masking and intravenous administration of sodium bicarbonate 4% in the calculation of 5 ml per 1 kg of the patient's weight with the obligatory control of laboratory parameters of the base and acid ratio is most effective.
The prognosis for the life of patients with existing signs of hypervitaminosis is usually favorable, except for cases of acute poisoning with vitamin-containing drugs in pediatric practice, provided there are no timely urgent measures. The onset of death is due in most cases to the development of acute toxic damage to the liver and myocardium.