Vitamin A is a fat-soluble vitamin naturally found in certain foods, such as meat and dairy products. It can also be consumed as a dietary supplement. This vitamin is stored in the liver. Hypervitaminosis A (HA) refers to the excessive consumption of vitamin A which leads to acute or chronic toxicity.

Usually, HA is caused by taking excessive amounts of vitamin A supplements, or the accidental ingestion of its topical forms, such as retinol. Acutely, patients may present with non-specific manifestations that include nausea, vomiting, and anorexia. Children may exhibit features such as failure to thrive, bulging of the fontanelles, visual disturbances, and premature closure of epiphyses. Similarly, visual changes and ocular signs occur in adults, and these may involve blurry vision, photophobia, and conjunctivitis.

Central nervous system (CNS) effects include a decreased level of consciousness, lethargy, ataxia, dizziness, headache, and irritability. Some of the CNS manifestations, namely papilledema and bulging of the fontanelles in infants, are due to raised intracranial pressure precipitated by HA.

HA also promotes an abnormal breakdown of bone tissue, which may lead to hypercalcemia and osteoporosis [1] [2] [3]. Further systemic consequences of HA are hepatotoxicity, hepatomegaly, splenomegaly, ascites, migratory arthritis, and hepatic hydrothorax [4] [5].

Chronic HA affects multiple systems, with features such as arthralgia, bone pain, hair loss, desquamation of skin, eczematous lesions, photosensitivity, and petechiae. Other cutaneous manifestations of HA include angular stomatitis, cheilitis, and brittle nails. Last but not least, hypervitaminosis A has teratogenic effects on the developing fetus.

• Fatigue

  Upon further questioning, her mother reported that she seemed more fatigued for a few weeks, had abdominal pain, and was urinating more frequently. [ncbi.nlm.nih.gov]

  At first I thought these things were due to pregnancy & post-partum hormones as well as chronic fatigue that I have battled for 12 years; but after reading about vitamin A toxicity I realized most of these symptoms occurred after I had been taking cod [easy-immune-health.com]

  Some studies have also reported fatigue, weakness, headache and gastrointestinal upset. Impaired immunity with secondary necrotising enterocolitis has been observed in premature infants given vitamin E to prevent retrolental fibroplasia. [patient.info]

  Weight loss Later symptoms may be of an underactive thyroid ( hypothyroidism ), including fatigue and cold intolerance, until the thyroid recovers. [mclaren.org]

  The chronic poisoning symptoms include: feeling of chronic fatigue, irritability, double vision, nystagmus, sleep disturbances, cracking and bleeding lips and gums, shedding of hair, rashes and ulceration of the skin, muscular coordination disturbances [flipper.diff.org]

• Splenomegaly

  Further systemic consequences of HA are hepatotoxicity, hepatomegaly, splenomegaly, ascites, migratory arthritis, and hepatic hydrothorax. [symptoma.com]

  Splenomegaly. Raised intracranial pressure. Stupor. Limited body movement. Cirrhosis of liver. Young children with acute hypervitaminosis A may show papilloedema and symptoms suggestive of pseudo-tumour cerebri. [nhp.gov.in]

• Nausea

  Clinical findings Bone pain, dry skin, gastrointestinal complaints (nausea, vomiting, constipation, diarrhoea), increased intracranial pressure, poor growth in children; affected infants may develop bulging fontanelles, craniotabes (softening of skull [medical-dictionary.thefreedictionary.com]

  Acutely, patients may present with non-specific manifestations that include nausea, vomiting, and anorexia. Children may exhibit features such as failure to thrive, bulging of the fontanelles, visual disturbances, and premature closure of epiphyses. [symptoma.com]

  More sustained intake of excess vitamin A leads to increased intracranial pressure (pseudotumour cerebri), dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death. [patient.info]

  Symptoms of acute vitamin A toxicity include: drowsiness irritability abdominal pain nausea vomiting increased pressure on the brain Symptoms of chronic vitamin A toxicity include: blurry vision or other vision changes swelling of the bones bone pain [healthline.com]

  Bulging of the soft spot in an infant's skull ( fontanelle ) Changes in alertness or consciousness Decreased appetite Dizziness Double vision (in young children) Drowsiness Hair changes, such as hair loss and oily hair Headache Irritability Liver damage Nausea [nlm.nih.gov]

• Vomiting

  Serum electrolytes: Vomiting and diarrhea may lead to derangements. High-performance liquid chromatography (HPLC). Lumbar puncture. Other useful tests include: X-rays: These may show abnormal bone calcification. Electrocardiography. [symptoma.com]

  Features of hypercalcaemia include polyuria, polydypsia, vomiting, anorexia, lethargy, dehydration, constipation, hypertension, tetany and seizures. The traditional description of hypercalcaemia is stones, bones and groans. [patient.info]

  Vomiting. Drowsiness. Less commonly, there may be diplopia, cranial nerve palsies, and symptoms suggestive of pseudo-tumour cerebri. [nhp.gov.in]

  Symptoms of acute vitamin A toxicity include: drowsiness irritability abdominal pain nausea vomiting increased pressure on the brain Symptoms of chronic vitamin A toxicity include: blurry vision or other vision changes swelling of the bones bone pain [healthline.com]

  […] hair Headache Irritability Liver damage Nausea Poor weight gain (in infants and children) Skin changes, such as cracking at corners of the mouth, higher sensitivity to sunlight, oily skin, peeling, itching, and yellow color to the skin Vision changes Vomiting [nlm.nih.gov]

• Abdominal Pain

  Upon further questioning, her mother reported that she seemed more fatigued for a few weeks, had abdominal pain, and was urinating more frequently. [ncbi.nlm.nih.gov]

  My youngest son (almost 4) had extremely yellow skin & abdominal pains last year for a couple of weeks & returned again a couple of weeks ago when we started on the cod liver oil after a 2 month abstinence. [easy-immune-health.com]

  Symptoms of acute vitamin A toxicity include: drowsiness irritability abdominal pain nausea vomiting increased pressure on the brain Symptoms of chronic vitamin A toxicity include: blurry vision or other vision changes swelling of the bones bone pain [healthline.com]

  Symptoms include: Headache Abdominal pain Nausea or vomiting Lethargy Visual changes Impaired consciousness Other features suggestive of raised intracranial pressure, such as bulging fontanelle (in an infant), papilloedema and diplopia, may also occur [patient.info]

  Acute hypervitaminosis A Abdominal pain Sleepiness Irritable mood Dizziness Chronic hypervitaminosis A Bone abnormalities and joint pain Jaundice Visual disturbances Loss of appetite Dizziness, confusion Loss of hair or alopecia Peeling, oily or itching [news-medical.net]

• Loss of Appetite

  These include the following: Acute Hypervitaminosis A: Vomiting and nausea Loss of appetite, weakness, drowsiness, irritability Blurred vision, headache Mental problems Pain, tenderness in muscle and bone (usually the limbs) Infants, children may have [dovemed.com]

  Other symptoms can be quite nonspecific: Scaly seborrhoeic eczema Patchy hair loss Stomatitis Loss of appetite Nausea Vomiting Malaise Hepatosplenomegaly Liver failure Raised intracranial pressure Children can present with craniotabes, irritability, failure [patient.info]

  Chronic Toxicity of Vitamin A long-term megadose; possible permanentdamage Bone and muscle pain Loss of appetite Skin disorders Headache Dry skin Hair loss Increased liver size [email protected] 32. [slideshare.net]

  Acute hypervitaminosis A Abdominal pain Sleepiness Irritable mood Dizziness Chronic hypervitaminosis A Bone abnormalities and joint pain Jaundice Visual disturbances Loss of appetite Dizziness, confusion Loss of hair or alopecia Peeling, oily or itching [news-medical.net]

  One man felt very nauseous, Stefansson suffered loss of appetite, the other two suffered no ill effects. 19 While some of the symptoms suffered by Mawson and Mertz occur in hypervitaminosis A, none were exclusively those of vitamin A toxicity. [mja.com.au]

• Cracked Lips

  My oldest daughter (11yrs old) has had bone pain every once in a while, seborrhea, cracked lips in the winter, & in the last 2 years had needed glasses for farsightedness (she hardly ever gets sun). [easy-immune-health.com]

• Hypertension

  Hypervitaminosis A may be associated with benign intracranial hypertension. So far, the explanation for this phenomenon has remained obscure. [ncbi.nlm.nih.gov]

  Wall M: The headache profile of idiopathic intracranial hypertension. Cephalalgia 1990, 10: 331–335. PubMed CrossRef Google Scholar 13. Friedman DI, Rausch EA: Headache diagnoses in patients with treated idiopathic intracranial hypertension. [doi.org]

  Features of hypercalcaemia include polyuria, polydypsia, vomiting, anorexia, lethargy, dehydration, constipation, hypertension, tetany and seizures. The traditional description of hypercalcaemia is stones, bones and groans. [patient.info]

• Hepatomegaly

  Further systemic consequences of HA are hepatotoxicity, hepatomegaly, splenomegaly, ascites, migratory arthritis, and hepatic hydrothorax. [symptoma.com]

  This article describes the common symptomatology of vitamin A toxicity, including hypercalcemia, hepatomegaly, and dermatological and neurological effects. Retinol supplements, but not carotene supplements, become toxic when free retinol circulates. [journals.lww.com]

  Hepatomegaly. Splenomegaly. Raised intracranial pressure. Stupor. Limited body movement. Cirrhosis of liver. Young children with acute hypervitaminosis A may show papilloedema and symptoms suggestive of pseudo-tumour cerebri. [nhp.gov.in]

  ChronicIntoxication Results when 50,000 IU/day ingested for several wksor more Signs & symptoms in infants: Early are anorexia, pruritus, irritability, tenderswollen bones w/motion limitation Alopecia, seborrhea, cheilosis & peeling of palms &soles Hepatomegaly [slideshare.net]

  Symptoms and signs of toxicity include dry skin, nausea, headache, fatigue, irritability, anorexia, liver disease and hepatomegaly, hair loss and alopecia, hyperostosis, high cholesterol and increased cerebrospinal fluid pressure [pseudotumour cerebri [caribbean.scielo.org]

• Hepatosplenomegaly

  Other signs and symptoms include anorexia, hepatosplenomegaly, irritability, scaly dermatitis, patchy hair loss, bone pain and hyperostosis. The lowest intake required to produce toxic symptoms is not known. [gpnotebook.co.uk]

  Acute pseudotumour cerebri Chronic pruritus, dry skin, dry lips soft tissue nodules diffuse symmetric periostitis (scintigraphy may allow earlier detection 2 ) may cause premature fusion of ossification centers separation of cranial sutures hepatosplenomegaly [radiopaedia.org]

  Abdominal ultrasound was normal except for hepatosplenomegaly. Fig. 1. Bone marrow appearance on admission. Marked decrease of nucleated erythroid cells with binucleate erythroblasts, absence of megakaryocyte, and normal myeloid cells. [bloodjournal.org]

  Other symptoms can be quite nonspecific: Scaly seborrhoeic eczema Patchy hair loss Stomatitis Loss of appetite Nausea Vomiting Malaise Hepatosplenomegaly Liver failure Raised intracranial pressure Children can present with craniotabes, irritability, failure [patient.info]

  Symptoms have included coarseness and sparseness of hair of the scalp, eyebrows and other parts of the body; dryness of the skin, ulceration, and desquamation; hepatosplenomegaly; anorexia and diarrhoea; cessation of menstruation; haemorrhagic tendency [mja.com.au]

• Alopecia

  A case of chronic hypervitaminosis A is reported in a 57-year-old woman who took vitamin preparations for alopecia. [ncbi.nlm.nih.gov]

  Alopecia. Swelling of bones. Diplopia (double vision). Irritability. Young children may have Lack of gain in weight. Pruritus (itching). Bulging fontanelles. [nhp.gov.in]

  Summary A case of chronic hypervitaminosis A is reported in a 57-year-old woman who took vitamin preparations for alopecia. [link.springer.com]

  Herein we present the case of a 60‐year‐old male with symptoms of muscle soreness, alopecia, nail dystrophy, and ascites. [doi.org]

  ChronicIntoxication Results when 50,000 IU/day ingested for several wksor more Signs & symptoms in infants: Early are anorexia, pruritus, irritability, tenderswollen bones w/motion limitation Alopecia, seborrhea, cheilosis & peeling of palms &soles [slideshare.net]

• Pruritus

  The clinical features included irritability, xerosis of the skin and mucous membranes, pruritus, bone pain, and loss of ambulation. The bone scan showed involvement of more bones than was apparent on the roentgenograms. [ncbi.nlm.nih.gov]

  Acute pseudotumour cerebri Chronic pruritus, dry skin, dry lips soft tissue nodules diffuse symmetric periostitis (scintigraphy may allow earlier detection 2 ) may cause premature fusion of ossification centers separation of cranial sutures hepatosplenomegaly [radiopaedia.org]

  Pruritus (itching). Bulging fontanelles. Acute hypervitaminosis A (such as consumption of a single large dose of 30- 60 mg of vitamin A) may lead to Nausea. Vomiting. Drowsiness. [nhp.gov.in]

  […] hair changes Cracking at corners of the mouth Hair loss Higher sensitivity to sunlight Oily skin and hair (seborrhea) Premature epiphyseal closure Skin peeling, itching Spontaneous fracture Yellow discoloration of the skin (aurantiasis cutis) Uremic pruritus [en.wikipedia.org]

  Scaly seborrhoeic eczema Patchy hair loss Stomatitis Loss of appetite Nausea Vomiting Malaise Hepatosplenomegaly Liver failure Raised intracranial pressure Children can present with craniotabes, irritability, failure to thrive, decreased appetite and pruritus [patient.info]

• Yellow Discoloration of the Skin

  discoloration of the skin Vision changes Vomiting Signs and tests Bone x-rays Blood calcium test Cholesterol test Liver function test Blood test to check vitamin A levels Treatment Treatment involves simply stopping the use of too much vitamin A. [coordinatedhealth.com]

  discoloration of the skin Vision changes Vomiting Exams and Tests Bone x-rays Blood calcium test Cholesterol test Liver function test Blood test to check vitamin A levels Treatment Treatment involves simply stopping the use of too much vitamin A. [healthmedicinet.com]

  discoloration of the skin (aurantiasis cutis) Uremic pruritus Vision changes Vomiting Hypervitaminosis A results from excessive intake of preformed vitamin A. [en.wikipedia.org]

• Diplopia

  Less commonly, there may be diplopia, cranial nerve palsies, and symptoms suggestive of pseudo-tumour cerebri. [nhp.gov.in]

  Symptoms include: Headache Abdominal pain Nausea or vomiting Lethargy Visual changes Impaired consciousness Other features suggestive of raised intracranial pressure, such as bulging fontanelle (in an infant), papilloedema and diplopia, may also occur [patient.info]

  Patients present with daily headache, pulse-synchronous tinnitus, transient visual obscurations, papilledema with its associated visual loss, and diplopia from sixth nerve paresis. [doi.org]

• Bone Pain

  The clinical features included irritability, xerosis of the skin and mucous membranes, pruritus, bone pain, and loss of ambulation. The bone scan showed involvement of more bones than was apparent on the roentgenograms. [ncbi.nlm.nih.gov]

  Chronic HA affects multiple systems, with features such as arthralgia, bone pain, hair loss, desquamation of skin, eczematous lesions, photosensitivity, and petechiae. [symptoma.com]

  Other signs and symptoms include anorexia, hepatosplenomegaly, irritability, scaly dermatitis, patchy hair loss, bone pain and hyperostosis. The lowest intake required to produce toxic symptoms is not known. [gpnotebook.co.uk]

  Symptoms include changes to vision, bone pain, and skin changes. Chronic toxicity can lead to liver damage and increased pressure on your brain. Hypervitaminosis A can be diagnosed using blood tests to check your vitamin A levels. [healthline.com]

  Symptoms may include: Abnormal softening of the skull bone (in infants and children) Blurred vision Bone pain or swelling Bulging of the soft spot in an infant's skull ( fontanelle ) Changes in alertness or consciousness Decreased appetite Dizziness Double [nlm.nih.gov]

• Arthralgia

  Chronic HA affects multiple systems, with features such as arthralgia, bone pain, hair loss, desquamation of skin, eczematous lesions, photosensitivity, and petechiae. [symptoma.com]

  fever, severe arthralgia, bone pain, plasma leakage, thrombocytopenia, headache, and gastrointestinal symptoms) are caused by the damaging effects of dengue virus-induced activation of hepatocytes and the resulting spillage of toxic retinoids (i.e. [flipper.diff.org]

• Hysteria

  Abstract The hysterical reaction among Eskimo peoples known as pibloktoq, one of a group of aberrant behaviors occurring among Arctic and Circumarctic societies termed 'arctic hysterias', has been explained by a variety of theories: ecological, nutritional [ncbi.nlm.nih.gov]

• Withdrawn

  A patient with juvenile chronic arthritis developed benign intracranial hypertension and other manifestations of excessive vitamin A intake and made a complete recovery after it was withdrawn. [ncbi.nlm.nih.gov]

• Irritability

  The clinical features included irritability, xerosis of the skin and mucous membranes, pruritus, bone pain, and loss of ambulation. The bone scan showed involvement of more bones than was apparent on the roentgenograms. [ncbi.nlm.nih.gov]

  There is also hyperesthesia, irritability, anorexia, weight loss, and sometimes neurological deficits. [medical-dictionary.thefreedictionary.com]

  Central nervous system (CNS) effects include a decreased level of consciousness, lethargy, ataxia, dizziness, headache, and irritability. [symptoma.com]

  Other signs and symptoms include anorexia, hepatosplenomegaly, irritability, scaly dermatitis, patchy hair loss, bone pain and hyperostosis. The lowest intake required to produce toxic symptoms is not known. [gpnotebook.co.uk]

  Bone pain or swelling Bulging of the soft spot in an infant's skull ( fontanelle ) Changes in alertness or consciousness Decreased appetite Dizziness Double vision (in young children) Drowsiness Hair changes, such as hair loss and oily hair Headache Irritability [nlm.nih.gov]

• Headache

  Findings included headache, confusion, skin desquamation, and hypercalcemia. Prior to developing hepatitis, he had ingested supplemental vitamin A without recognized ill effect. Liver and serum vitamin A without recognized ill effect. [ncbi.nlm.nih.gov]

  Manifestations include bone fragility, xeroderma, nausea, headache, and loss of hair. hypervitaminosis a condition produced by ingestion or injection of excessive amounts of vitamins; symptom complexes are associated with excessive intake of vitamins [medical-dictionary.thefreedictionary.com]

  Central nervous system (CNS) effects include a decreased level of consciousness, lethargy, ataxia, dizziness, headache, and irritability. [symptoma.com]

  The condition was first described in Arctic explorers who developed headache, diarrhoea and dizziness after eating polar bear liver. [gpnotebook.co.uk]

  Blurred vision Bone pain or swelling Bulging of the soft spot in an infant's skull ( fontanelle ) Changes in alertness or consciousness Decreased appetite Dizziness Double vision (in young children) Drowsiness Hair changes, such as hair loss and oily hair Headache [nlm.nih.gov]

• Lethargy

  Central nervous system (CNS) effects include a decreased level of consciousness, lethargy, ataxia, dizziness, headache, and irritability. [symptoma.com]

  Signs : anorexia, weight loss, lethargy, neck stiffness, lameness, progressive ankylosis characteristic 'kangaroo' stance. Diagnosis : radiology demonstrating cervical ankylosis and subperiosteal new bone; serology. [vetstream.com]

  Features of hypercalcaemia include polyuria, polydypsia, vomiting, anorexia, lethargy, dehydration, constipation, hypertension, tetany and seizures. The traditional description of hypercalcaemia is stones, bones and groans. [patient.info]

When HA is suspected, there are several biochemical tests and radiological modalities available to confirm the diagnosis and assess effects of the disease. The biochemical tests include:

• Serum vitamin A levels: The normal range is 20-60 micrograms per deciliter. In patients with HA, vitamin A levels will be above 60-100 micrograms per deciliter.
• Serum calcium levels: These may be elevated [6].
• Random blood glucose test.
• Complete blood count: This is requested to rule out anemia, leukopenia, or thrombocytopenia.
• Serum cholesterol levels.
• Liver function tests.
• Serum electrolytes: Vomiting and diarrhea may lead to derangements.
• High-performance liquid chromatography (HPLC).
• Lumbar puncture.

Other useful tests include:

• X-rays: These may show abnormal bone calcification.
• Electrocardiography.
• Bone mineral density: Chronic toxicity causes reduced bone density [7].

It is advised that drug levels of aspirin and paracetamol also be checked.

• HLA-B27

  Tests were negative for the HLA-B27 antigen in all 3 patients. Serum vitamin A levels were high, ranging from 894 to 1123 microg/L (normal, 489-720). None of the patients reported taking retinoids or having unusual eating habits. [ncbi.nlm.nih.gov]

1. Scheven BAA, Hamilton NJ. Retinoic acid and 1,25-dihydroxyvitamin D3 stimulate osteoclast formation by different mechanisms. Bone. 1990;11(1):53-59.
2. National Institutes of Health Office of Dietary Supplements. Vitamin A Fact Sheet for Health Professionals. National Institutes of Health. http://ods.od.nih.gov/factsheets/vitamina.asp. Accessed September 15, 2017.
3. Ribaya-Mercado JD, Blumberg JB. Vitamin A: is it a risk factor for osteoporosis and bone fracture? Nutr Rev. 2007;65(10):425-438.
4. Miksad R, de Lédinghen V, McDougall C, Fiel I, Rosenberg H. Hepatic hydrothorax associated with vitamin a toxicity. J Clin Gastroenterol. 2002;34(3):275-279.
5. Hathcock JN, Hattan DG, Jenkins MY, McDonald JT, Sundaresan PR, Wilkening VL. Evaluation of vitamin A toxicity. Am J Clin Nutr. 1990;52(2):183-202.
6. Bhalla K, Ennis DM, Ennis ED. Hypercalcemia caused by iatrogenic hypervitaminosis A. J Am Diet Assoc. 2005;105(1):119-121.
7. Barker ME, Blumsohn A. Is vitamin A consumption a risk factor for osteoporotic fracture? Proc Nutr Soc. 2003;62(4):845-850.