Hypervitaminosis A Inducing Intra-hepatic Cholestasis—A Rare Case Report

Ramanathan, Vivek; Hensley, Gary; French, Samuel W.; Ve, Eysselein; Chung, Denise; Reicher, Sofiya; Pham, Binh V.

doi:10.1016/j.yexmp.2009.11.007

Cited by 32 publications

(26 citation statements)

References 8 publications

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“…The ease of its accumulation in the body and the difficulty of disposing excess amounts, leads to a high likelihood of hypervitaminosis (vitamin toxicity). The symptoms of both acute and chronic hypervitaminosis A, with symptoms for chronic being more severe, may be nausea, jaundice, irritability, anorexia, vomiting, blurry vision, headaches, hair loss, muscle and abdominal pain, weakness, drowsiness, an altered mental state (RAmAnAthAn et al, 2009), and increased susceptibility to infections, which is due to a weakened immune system (ChAndrA, 1993).…”

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confidence: 99%

Effects of vitamin A overdose on rat’s organs involved in immunity and vitamin A storage

Mahassni¹,

Alshaikh²

2014

Acta Alimentaria

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Vitamin A overdose is a common occurrence due to food fortification and ingestion of vitamin A supplements. Vitamin A is a nutrient that possesses known and potential effects on general health and the immune response. This research work is an in vivo investigation of the effects of administration of vitamin A above dietary requirements on some organs involved in immunity, vitamin A storage, and metabolism in healthy male rats. A total of 60 young adult male Wistar rats were equally divided into three groups. Rats in the two test groups were orally administered with vitamin A at different concentrations (8000 and 15 000 IU kg -1 body weight) for 21 days, while the control rats did not receive any supplementation. Weekly body weights and weights of the liver, kidney, spleen, and thymus were measured. Histological evaluations were carried out on the liver, kidney, thymus, and Peyer's patches. Findings show that vitamin A did not significantly affect body and organs' weights, except for a significant decrease of spleen weights for both experimental groups. Vitamin A was found to lead to some changes in the histology of the tested organs. This is the first study of its kind and sets a base for future studies.

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confidence: 99%

Effects of vitamin A overdose on rat’s organs involved in immunity and vitamin A storage

Mahassni¹,

Alshaikh²

2014

Acta Alimentaria

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“…Considerable interest focused on the question whether few Herbalife products are potentially hepatotoxic like some other herbal products and dietary supplements [1][2][3][4][5][6][7][8][9][10] . These reports created safety concerns and led to editorials [11][12][13] , commentaries [14][15][16] , and critical Letters to the Editor [17][18][19][20][21][22][23][24][25][26][27] , all addressing relevant issues [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”

Section: Introductionmentioning

confidence: 99%

“…These reports created safety concerns and led to editorials [11][12][13] , commentaries [14][15][16] , and critical Letters to the Editor [17][18][19][20][21][22][23][24][25][26][27] , all addressing relevant issues [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Speculations about bacterial contamination with Bacillus subtilis in Herbalife products emerged [8,12] , and potentially hepatotoxic ingredients such as green tea extracts, ephedra sinica, aloe, or vitamin A overdose have been proposed as culprits [2][3][4]10] . In addition, overall case data quality was mixed due to confounding variables, missing firm exclusion of alternative explanations, and the use of problematic causality attribution methods [1][2][3][4][5][6][7]…”

Section: Introductionmentioning

confidence: 99%

“…Speculations about bacterial contamination with Bacillus subtilis in Herbalife products emerged [8,12] , and potentially hepatotoxic ingredients such as green tea extracts, ephedra sinica, aloe, or vitamin A overdose have been proposed as culprits [2][3][4]10] . In addition, overall case data quality was mixed due to confounding variables, missing firm exclusion of alternative explanations, and the use of problematic causality attribution methods [1][2][3][4][5][6][7][8][9][10] . For hepatotoxicity cases, even with stringent causality assessment the culprits remain undetected in up to 38% of severe liver disease [28] , and alternative causes are frequently found [16,29,30] , with up to 47% in initially assumed drug induced liver injury (DILI) cases [16,29] and with an average of 49% in initially suspected herb induced liver injury (HILI) cases [30] .…”

Section: Introductionmentioning

confidence: 99%

“…For hepatotoxicity cases, even with stringent causality assessment the culprits remain undetected in up to 38% of severe liver disease [28] , and alternative causes are frequently found [16,29,30] , with up to 47% in initially assumed drug induced liver injury (DILI) cases [16,29] and with an average of 49% in initially suspected herb induced liver injury (HILI) cases [30] . When adjusted for case duplications, Herbalife hepatotoxicity was suspected in 53 cases [1][2][3][4][5][6][7][8][9][10] . Among these were eight cases with high causality gradings for Herbalife products because of positive unintentional reexposure tests, though criteria to evaluate reexposure tests were not presented [1][2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

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Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests

Teschke¹,

Frenzel²,

Schulze³

et al. 2013

WJH

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AIM:To analyze the validity of applied test criteria and causality assessment methods in assumed Herbalife hepatotoxicity with positive reexposure tests. METHODS:We searched the Medline database for suspected cases of Herbalife hepatotoxicity and retrieved 53 cases including eight cases with a positive unintentional reexposure and a high causality level for Herbalife. First, analysis of these eight cases focused on the data quality of the positive reexposure cases, requiring a baseline value of alanine aminotransferase (ALT) < 5 upper limit of normal (N) before reexposure, with N as the upper limit of normal, and a doubling of the ALT value at reexposure as compared to the ALT value at baseline prior to reexposure. Second, reported methods to assess causality in the eight cases were evaluated, and then the liver specific Council for International Organizations of Medical Sciences (CIOMS) scale validated for hepatotoxicity cases was used for quantitative causality reevaluation. This scale consists of various specific elements with scores provided through the respective case data, and the sum of the scores yields a causality grading for each individual case of initially suspected hepatotoxicity. RESULTS:Details of positive reexposure test conditions and their individual results were scattered in virtually all cases, since reexposures were unintentional and allowed only retrospective rather than prospective assessments. In 1/8 cases, criteria for a positive reexposure were fulfilled, whereas in the remaining cases the reexposure test was classified as negative (n = 1), or the data were considered as uninterpretable due to missing information to comply adequately with the criteria (n = 6). In virtually all assessed cases, liver unspecific causality assessment methods were applied rather than a liver specific method such as the CIOMS scale. Using this scale, causality gradings for Herbalife in these eight cases were probable (n = 1), unlikely (n = 4), and excluded (n = 3). Confounding variables included low data quality, alternative diagnoses, poor exclusion of important other causes, and comedication by drugs and herbs in 6/8 cases. More specifically, problems were evident in some cases regarding temporal association, daily doses, exact start and end dates of product use, actual data of laboratory parameters such as ALT, and exact dechallenge characteristics. Shortcomings included scattered exclusion of hepatitis A-C, cytomegalovirus and Epstein Barr virus infection with only globally presented or lacking parameters. Hepatitis E virus infection was considered in one single patient and found positive, infections by herpes simplex ORIGINAL ARTICLE

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Nutritional Biochemistry in the Post‐operative Patient

Livingstone

2023

Nutritional Management of the Surgical Patient

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Hypervitaminosis A Inducing Intra-hepatic Cholestasis—A Rare Case Report

Cited by 32 publications

References 8 publications

Effects of vitamin A overdose on rat’s organs involved in immunity and vitamin A storage

Effects of vitamin A overdose on rat’s organs involved in immunity and vitamin A storage

Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests

Nutritional Biochemistry in the Post‐operative Patient

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