From the Guidelines
Vitamin E toxicity in children typically occurs at doses exceeding 400-1000 IU/kg/day, with a maximum recommended dose of 11 mg/day for infants and children below 11 years. For a typical child, this would mean consuming more than 1,000-5,000 IU daily for extended periods, with the exact dose depending on the child's age and weight 1. The symptoms of vitamin E toxicity in children may include nausea, headache, fatigue, blurred vision, increased bleeding tendency, and gastrointestinal distress. The risk increases in children taking anticoagulant medications as vitamin E has antiplatelet effects. Vitamin E is fat-soluble and accumulates in the body over time, which is why chronic excessive intake is more concerning than single large doses. Some key points to consider when assessing vitamin E toxicity in children include:
- The Tolerable Upper Intake Level for children varies by age, but the maximum recommended dose is 11 mg/day for infants and children below 11 years 1.
- Preterm infants have different vitamin E requirements, with a recommended dose of 2.8-3.5 mg/kg/day 1.
- The use of new-generation lipid emulsions containing vitamin E can help maintain normal vitamin E levels in children receiving parenteral nutrition 1.
- Discontinuation of supplements is the primary treatment for vitamin E toxicity, and symptoms typically resolve gradually as levels normalize. It is essential to monitor children for signs of vitamin E toxicity, especially those receiving high doses or taking anticoagulant medications, and to adjust the dose accordingly to prevent toxicity 1.
From the FDA Drug Label
• Precautions As with all vitamin products, parents should be cautioned against excessive dosage. The bottle should be kept out of the reach of children. The FDA drug label does not answer the question.
From the Research
Vitamin E Toxicity in Pediatrics
- The toxic dose of vitamin E in pediatric patients is not well established, but high doses have been associated with adverse effects such as increased frequency of necrotizing enterocolitis (NEC) and sepsis 2.
- Elevated dosages of vitamin E have been used in infants and children to treat vitamin E deficiency syndromes, but the use of high doses is controversial due to the potential for adverse effects 2.
- There is limited data on the pharmacokinetics and dosing of oral vitamin E in children, and dosage recommendations vary widely 3.
Adverse Effects of High-Dose Vitamin E
- High doses of vitamin E have been associated with adverse effects such as hemolytic anemia, thrombocytosis, and edema in preterm infants 2.
- Vitamin E toxicity can also cause hepatic injuries and increase the risk of bleeding due to its anticoagulant effects 2, 4.
- The interaction between vitamin E and vitamin K is complex, and high doses of vitamin E may antagonize vitamin K, leading to poor vitamin K status 4.