Hypervitaminosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
E67 Other overeating
E67.0 Hypervitaminosis A
E67.1 Hypercarotenemia
E67.2 Hypervitaminosis B6
E67.3 Hypervitaminosis D
E67.8 Other specified overeating
ICD-10 online (WHO version 2019)

As Hypervitaminosis those phenomena (symptoms) are combined that with excessive, lying about the need to supply the appropriate vitamins , for example, as oversupply through diet in the form of dietary supplements or vitamin supplements, but also for parenteral can transfer to occur.

Symptoms of overdose are much more likely to occur with the fat-soluble vitamins (especially with vitamins A and D ), as these cannot be excreted via the kidneys like the water-soluble vitamins. An overdose can therefore occur acutely with a 50-100 times daily dose or chronically with long-term ingestion of only slightly excessive doses (vitamin A from about 5 times the daily dose). Diet-related hypervitaminosis can practically only occur with vitamin A from the liver or cod liver oil .

A vitamin deficiency is called hypovitaminosis, and a lack of vitamins is called avitaminosis .

Vitamin A

Historical

The first documented death from hypervitaminosis A (also called A-hypervitaminosis ) was long considered to be Xavier Mertz , a Swiss polar explorer who took part in Douglas Mawson's Antarctic expedition. Lacking other supplies, he and Mawson ate slaughtered Greenland dogs , including their vitamin A- rich liver . A more recent study comes to the conclusion that the man, who had previously been a strictly vegetarian and was under severe psychological stress, could not tolerate the switch to a purely carnal diet.

Hypervitaminosis A in infants was formerly known as Marie-Sée syndrome - after a description from 1954 by the French pediatricians Julien Marie and Georges Sée.

Prehistoric

Kamoya Kimeu discovered the female skeleton of a Homo erectus ( KNM-ER 1808 ) at Lake Turkana in Africa , which had the types of bone malformations typical of hypervitaminosis A. This was the first evidence that Homo erectus was a carnivore, as the only way to get this form of the disease is through persistent consumption of the liver by carnivores.

Acute symptoms of intoxication

Acute poisoning symptoms were first observed in the polar explorers, the polar bear had eaten liver - Inuit do not eat them. In the event of a short-term and high overdose (100 times the daily requirement and more), the following symptoms may occur:

Chronic symptoms of intoxication

Symptoms of intoxication can occur after months or years of increased retinol intake, which significantly exceeds the daily requirement. It is difficult to define a limit value above which there is a risk: Since the vitamin accumulates in the body, it depends on the accumulated amount (duration of intake × amount) and the physical disposition. This should also be considered when using retinoids in acne therapy . The following symptoms are possible:

During pregnancy , the daily intake of vitamin A should not exceed 10,000 IU or 3 mg per day, as otherwise child malformations such as craniofacial abnormalities or heart valve defects can occur, although spontaneous miscarriages are also possible.

The vitamin A acid derivative isotretinoin (13-cis-retinoic acid), which is used to treat severe forms of acne , can cause dryness of the skin and mucous membranes and, in rare cases, joint and muscle problems. The effect of dryness is also desired by the treatment, since it leads to a peeling process, in the course of which the skin becomes thinner and acne disappears. However, since the entire skin and mucous membranes are affected, it is usually interpreted as an undesirable side effect. Above all, however, a connection with child malformations was established, so that with such a treatment adequate contraception must be ensured for a certain time after the end of the treatment. It is contraindicated in pregnant women.

Hypervitaminosis A can only occur with the intake of retinol , but not its precursor products - the conversion of carotenoids to retinol is regulated according to the body's needs. However, a strong yellowing of the skin ( carotenemia ) - but not the sclera - can occur if more than 30 mg beta-carotenes are taken daily , whereby patients with an underactive thyroid are particularly susceptible.

Vitamin sources

Retinol is found primarily in the liver of certain marine fish such as halibut and various species of shark, as well as certain mammals such as the seal and polar bear. Another source of danger is the uncritical intake of vitamin preparations, which can lead to side effects .

Studies

Excessive intake of vitamin A could lead to increased bone fractures in old age, according to a Swedish long-term study published in the New England Journal of Medicine .

Nicotinic acid (vitamin B 3 )

With an intake of> 500 mg nicotinic acid per day the skin vasodilator effect (flush) occurs. If the amount exceeds 2500 mg per day, the blood pressure may fall, dizziness may occur and the uric acid level in the blood increased.

Vitamin B₆

Although overdosing is mentioned again and again, one rarely comes across specific cases in the specialist literature, and when it does, it becomes clear that the cases are exotic. For example, overdose reactions with vitamin B6 are only described in the literature from 1,000 mg daily. The prerequisite is taking it for months. Schaumburg, et al. (1983) described toxic reactions after patients ingested 2,000–6,000 mg for 2–40 months. Sensitive people are said to have felt side effects from 500 mg daily. In rare cases, sensory nerve damage is possible from a daily dose of 50 mg. On average, symptoms of poisoning occurred after 35 months. The symptoms express themselves in the form of hyperesthesia , paresthesia , muscle weakness , numbness and loss of proprioception and vibration sensation . Overdose reactions are in most cases temporary, but in rare cases with particularly high doses they can also lead to permanent damage. The safe dose for humans is a maximum of 10 mg daily. In general, dosages between 2 and 10 g per day can lead to neurological disorders. In rare cases, intolerance reactions to sunlight occurred after taking high doses of B6. However, vitamin B6 hypervitaminosis can also occur in the context of a genetic disease, hypophosphatasia . At the same time, alkaline phosphatase (AP) is lowered as a key parameter . Recently there has been diagnostics and enzyme replacement therapy for this disease .

vitamin C

In individual cases, vitamin C , especially when consumed on an empty stomach, is associated with indigestion due to acidification of the stomach. This can be avoided, among other things, by taking in vitamin C not as ascorbic acid but as ascorbate (salt of ascorbic acid, e.g. sodium ascorbate). This can be achieved, for example, by adding baking powder or half the amount of baking soda . Aqueous solutions of ascorbic acid which have been made alkaline, however, have reduced stability. People with a tendency to develop kidney stones (oxalate type) should consult their doctor before taking high doses. Less than one percent of the population is affected by this problem.

Vitamin D

See article: " Hypervitaminosis D "

Vitamin K

There are hardly any vitamin K overdoses. Vitamin K 1 is non-toxic, but vitamin K 3 vitaminosis can lead to hemolytic anemia and liver damage. Newborns are particularly affected by this due to their not yet fully developed elimination capacity.

literature

  • Jeremy M. Berg, John L. Tymoczko, Lubert Stryer : Biochemistry. 6th edition. Spectrum Akademischer Verlag, Heidelberg 2007, ISBN 978-3-8274-1800-5 .
  • Donald Voet, Judith G. Voet: Biochemistry. 3. Edition. John Wiley & Sons, New York 2004. ISBN 0-471-19350-X .
  • Bruce Alberts , Alexander Johnson, Peter Walter, Julian Lewis, Martin Raff, Keith Roberts: Molecular Biology of the Cell . 5th edition. Taylor & Francis 2007, ISBN 978-0-8153-4106-2 .

Web links

Individual evidence

  1. ^ Ludwig Weissbecker: A hypervitaminosis (carotenemia). In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, p. 1085.
  2. ^ J. Cleland and RV Southcott: Hypervitaminosis A in the Antarctic in the Australasian Antarctic Expedition of 1911–1914: a possible explanation of the illness of Mertz and Mawson. In: Med. J. Aust. 1, 1969, pp. 1337-1342 (English)
  3. ↑ DJ Shearman: Vitamin A and Sir Douglas Mawson. In: Brit. Med. J. 1, 1978, pp. 283-285 (English)
  4. ↑ Denise Carrington-Smith: Mawson and Mertz: a re-evaluation of their ill-fated mapping journey during the 1911–1914 Australasian Antarctic Expedition . In: Med. J. Aust. 183, 2005, pp. 638-641, accessed January 6, 2009.
  5. ↑ Where named it
  6. ↑ J. Marie, G. See: Acute hypervitaminosis A of the infant; its clinical manifestation with benign acute hydrocephalus and pronounced bulge of the fontanel; a clinical and biologic study . In: AMA American journal of diseases of children . tape 87 , no. 6 , June 1954, ISSN  2374-2941 , pp. 731-736 , PMID 13157631 (English).
  7. ^ Alan Walker , Michael R. Zimmerman and Richard Leakey : A possible case of hypervitaminosis A in Homo erectus. In: Nature. Volume 296, 1982, pp. 248-250, doi: 10.1038 / 296248a0
  8. ↑ Sabina Bastos Maia et al .: Vitamin A and Pregnancy: A Narrative Review . In: Nutrients , March 2019, 11 (3), p. 681, PMID 30909386 , PMC 6470929 (free full text), doi: 10.3390 / nu11030681
  9. ^ New England Journal of Medicine , 2003, 348, pp. 287-294
  10. ↑ Department of Health, Committee On Toxicity of Chemicals In Food, Consumer Products And The Environment (Ed.): Statement On Vitamin B6 (Pyridoxine) Toxicity . June 1997 ( gov.uk [PDF]).
  11. ↑ Leitzmann, Müller, Michel, Brehme, Triebel, Hahn, Laube: Nutrition in Prevention and Therapy . 3. Edition. In: Hippokrates , 2009, p. 60