Liver damage caused by excess vitamin A intake

Nutrition Research Newsletter, June, 1991

It has long been known that extremely large doses of vitamin A can cause liver damage; however, low "therapeutic" doses have not been implicated previously. This series of cases, reported by physicians from St-Luc University Hospital in Brussels, presents a different picture.

Forty-one consecutive cases of vitamin A hepatotoxicity were retrospectively reviewed. Before liver biopsy, vitamin A toxicity was suspected in only 13 cases (32%). In the other 68%, typical biopsy results (fat-storing cell hyperplasia with fluorescent vacuoles) suggested vitamin A toxicity, and the history of vitamin A ingestion was then elicited from the patient.

A complete spectrum of liver lesions was observed, including increased storage in nine cases, noncirrhotic portal hypertension in five, mild chronic hepatitis in 10, and cirrhosis in 17. During a mean follow-up of 4.6 years, six patients died of their liver disease.

A precise history of vitamin A intake was obtained from 29 patients. The vitamin had often been taken at doses believed to be within the therapeutic range. In one patient, an intake of 25,000 IU daily for six years produced cirrhosis. The total cumulated intake appeared to be the critical factor; the mean total dose in the 29 patients was 229 [+ or -] 57.7 x [10.sup.6] IU (366 [+ or -] 94 x [10.sup.6] IU in cirrhosis patients; 91 [+ or -] 40 x [10.sup.6] IU in noncirrhotic patients).

"Vitamin A-related hepatotoxicity may represent a significant health problem, likely often overlooked because the diagnosis mainly relies on expert liver biopsy interpretation.... Unsupervised consumption of 'therapeutic' doses of the vitamin originally intended for the treatment of benign conditions may lead to severe life-threatening liver damage."

Andre P Geubel et al, Liver Damage Caused by Therapeutic Vitamin A Administration: Estimate of Dose-Related Toxicity in 41 Cases, Gastroenterology 100(6):1701-1709 (June 1991) [Reprints: Andre P Geubel, MD, Department of Gastroenterology, St-Luc University Hospital, 10 avenue Hippocrate, 1200 Brussels, Belgium]