Hypervitaminosis A Following Long- Term Use of High-Dose Fish 011 Supplements Blair P. Grubb, M.D.
The use of various dietary supplements containing fish oils has become popular as a method of reducing the risk of developing cardiovascular disease. However, consumption of large amounts of these substances may pose some potential hazards. Described herein is a patient who developed hypervitaminosis A after prolonged fish oil supplement ingestion. (Cheat 1990; 97:1!60)
T
he use of fish oil supplements recently has become quite popular as a potential method of lowering plasma lipids, inhibiting platelet aggregation, decreasing blood pressure and increasing plasma HDL levels.' However, the consumption of large dosages of these substances may not be without risk, as they may contain relatively high levels of both vitamins A and D. 2 Reported here is a case of hypervitaminosis A secondary to chronic fish oil capsule ingestion alone. CASE REPORT
A 35-year-old white man presented complaining of anorexia, nausea, fatigue and mild frontal headache. He had been well until approximately one year prior to presentation when he began to consume between 30 and 50 capsules a day of various commercial fish oil preparations. These principally included Max EPA (R. P. Scherer Company, Clearwater, FL), Pro Mega (Parke-Davis Co, Morris Plains, NJ), EPA-Chol (People's Drugs, Alexandria, VA), Twin EPA (Twin Labs, Rokenkona, NY) and Super EPA (Pharmacaps, Inc, Elizabeth, NJ). He reported taking no other medications or vitamin supplements during this time, nor did he report high dietary sources of vitamin A. However, it was later round that the patient had also consumed an undetermined number of cod liver oil capsules during that year. Approximately one month prior to presentation he began to notice chronic fatigue and malaise as well as dry and itchy skin. One week prior to admission he began to complain of myalgia, anorexia and nausea and two days prior he began to have episodes of vomiting. Vital signs showed a blood pressure of 120180 mm Hg, a respiration rate of 16 breaths per minute, a pulse rate of 80 beats per minute and a temperature of 38.3"C orally. On physical examination, he was noted to have diffusely dry skin with fissures around the mouth. Ophthalmologic examination showed no papilledema. Pulmonary, cardiac and neurologic examinations were unremarkable. Abdominal examination revealed mild hepatomegaly but was otherwise unremarkable. A scan of the liver and spleen showed hepatomegaly with a liver size of 14 em. The electrolyte, BUN, creatinine, calcium and alkaline phosphatase levels were normal as were the complete blood cell count and urinalysis findings. The SGOf was elevated to 102 lUlL (normal, 10 to 40 lUlL) and the SGPT was 80 lUlL (normal,
The use of various dietary supplements containing fish oils has become popular as a method of reducing the risk of developing cardiovascular disease. However, consumption of large amounts of these substances may pose some potential hazards. Described herein is a patient who developed hypervitaminosis A after prolonged fish oil supplement ingestion. (Cheat 1990; 97:1!60)
T
he use of fish oil supplements recently has become quite popular as a potential method of lowering plasma lipids, inhibiting platelet aggregation, decreasing blood pressure and increasing plasma HDL levels.' However, the consumption of large dosages of these substances may not be without risk, as they may contain relatively high levels of both vitamins A and D. 2 Reported here is a case of hypervitaminosis A secondary to chronic fish oil capsule ingestion alone. CASE REPORT
A 35-year-old white man presented complaining of anorexia, nausea, fatigue and mild frontal headache. He had been well until approximately one year prior to presentation when he began to consume between 30 and 50 capsules a day of various commercial fish oil preparations. These principally included Max EPA (R. P. Scherer Company, Clearwater, FL), Pro Mega (Parke-Davis Co, Morris Plains, NJ), EPA-Chol (People's Drugs, Alexandria, VA), Twin EPA (Twin Labs, Rokenkona, NY) and Super EPA (Pharmacaps, Inc, Elizabeth, NJ). He reported taking no other medications or vitamin supplements during this time, nor did he report high dietary sources of vitamin A. However, it was later round that the patient had also consumed an undetermined number of cod liver oil capsules during that year. Approximately one month prior to presentation he began to notice chronic fatigue and malaise as well as dry and itchy skin. One week prior to admission he began to complain of myalgia, anorexia and nausea and two days prior he began to have episodes of vomiting. Vital signs showed a blood pressure of 120180 mm Hg, a respiration rate of 16 breaths per minute, a pulse rate of 80 beats per minute and a temperature of 38.3"C orally. On physical examination, he was noted to have diffusely dry skin with fissures around the mouth. Ophthalmologic examination showed no papilledema. Pulmonary, cardiac and neurologic examinations were unremarkable. Abdominal examination revealed mild hepatomegaly but was otherwise unremarkable. A scan of the liver and spleen showed hepatomegaly with a liver size of 14 em. The electrolyte, BUN, creatinine, calcium and alkaline phosphatase levels were normal as were the complete blood cell count and urinalysis findings. The SGOf was elevated to 102 lUlL (normal, 10 to 40 lUlL) and the SGPT was 80 lUlL (normal,
