Clinica chimica acta; international journal of clinical chemistry · 2026
Clinical Spectrum and Management of Hypervitaminosis A: A Systematic Review of Case-Based Evidence.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Padmakar Somanaboina
Аннотация
BACKGROUND: Hypervitaminosis A, caused by excessive intake or pathological accumulation of vitamin A, can lead to severe and diverse adverse effects across multiple organ systems. With rising availability of over-the-counter supplements and expanding food fortification programmes, the evidence base remains fragmented and primarily reliant on sporadic case reports. This systematic review synthesizes available evidence on the adverse effects and management of hypervitaminosis A.
METHODS: This systematic review was conducted according to the PRISMA 2020 guidelines. The literature was searched using various databases like PubMed, Scopus, Embase and Web of Science up to January 15, 2026 without any language restriction. The literature search, study selection, data extraction, and quality assessment of the included studies were performed by the author using a standardized extraction form with self-verification. JBI critical appraisal checklists were applied across all study designs: the 8-item tool for case reports, the 9-item tool for prevalence studies, and the 11-item tool for cohort studies. The inclusion criteria for this study included peer-reviewed literature like observational study, case reports, and case series among human subjects experiencing side effects or toxicity due to hypervitaminosis A.
FINDINGS: From an initial pool of 326 literature, after screening and exclusion, a total of 31 studies were included in this review, comprising case reports (n = 26, 83.9%), case series (n = 3, 9.7%), one observational study (n = 1, 3.2%), and one retrospective study (n = 1, 3.2%). The literature was published primarily in the USA (n = 10, 32.3%). Various sources of vitamin A toxicity were reported, most commonly vitamin A capsules or tablets (n = 21, 67.7%). The most common adverse effect was hypercalcemia (n = 9, 29.0%), followed by gastrointestinal manifestations (n = 8, 25.8%), neurological manifestations (n = 7, 22.6%), hepatobiliary manifestations (n = 7, 22.6%), musculoskeletal manifestations (n = 6, 19.4%), and dermatological manifestations (n = 5, 16.1%). Acute toxicity commonly presented with neurological symptoms including headache, diplopia, and raised intracranial pressure, whereas chronic toxicity was more frequently associated with hepatobiliary complications, musculoskeletal manifestations, and hypercalcemia. The treatment includes discontinuation of vitamin A intake, bisphosphonates, prednisone, intravenous fluids, calcitonin, orthopaedic surgery, and liver transplantation.
CONCLUSION: Hypervitaminosis A, particularly arising from non-prescription supplement misuse, mimics various disorders and presents commonly with hypercalcemia and neurological dysfunction. It is a preventable condition requiring early recognition, prompt discontinuation of vitamin A intake, and appropriate symptomatic management. A thorough dietary and supplementation history is essential for timely diagnosis.
METHODS: This systematic review was conducted according to the PRISMA 2020 guidelines. The literature was searched using various databases like PubMed, Scopus, Embase and Web of Science up to January 15, 2026 without any language restriction. The literature search, study selection, data extraction, and quality assessment of the included studies were performed by the author using a standardized extraction form with self-verification. JBI critical appraisal checklists were applied across all study designs: the 8-item tool for case reports, the 9-item tool for prevalence studies, and the 11-item tool for cohort studies. The inclusion criteria for this study included peer-reviewed literature like observational study, case reports, and case series among human subjects experiencing side effects or toxicity due to hypervitaminosis A.
FINDINGS: From an initial pool of 326 literature, after screening and exclusion, a total of 31 studies were included in this review, comprising case reports (n = 26, 83.9%), case series (n = 3, 9.7%), one observational study (n = 1, 3.2%), and one retrospective study (n = 1, 3.2%). The literature was published primarily in the USA (n = 10, 32.3%). Various sources of vitamin A toxicity were reported, most commonly vitamin A capsules or tablets (n = 21, 67.7%). The most common adverse effect was hypercalcemia (n = 9, 29.0%), followed by gastrointestinal manifestations (n = 8, 25.8%), neurological manifestations (n = 7, 22.6%), hepatobiliary manifestations (n = 7, 22.6%), musculoskeletal manifestations (n = 6, 19.4%), and dermatological manifestations (n = 5, 16.1%). Acute toxicity commonly presented with neurological symptoms including headache, diplopia, and raised intracranial pressure, whereas chronic toxicity was more frequently associated with hepatobiliary complications, musculoskeletal manifestations, and hypercalcemia. The treatment includes discontinuation of vitamin A intake, bisphosphonates, prednisone, intravenous fluids, calcitonin, orthopaedic surgery, and liver transplantation.
CONCLUSION: Hypervitaminosis A, particularly arising from non-prescription supplement misuse, mimics various disorders and presents commonly with hypercalcemia and neurological dysfunction. It is a preventable condition requiring early recognition, prompt discontinuation of vitamin A intake, and appropriate symptomatic management. A thorough dietary and supplementation history is essential for timely diagnosis.