title: A Case Report of Acute Vitamin A Intoxication due to Ocean Perch Liver Ingestion.
abstract: BACKGROUND
  Chronic vitamin A intoxication is well known; however, there are few reports of acute vitamin A intoxication due to the ingestion of food rich in vitamin A, particularly in adults.
  
  
  METHODS
  We report a case of a 27-year-old man presenting with chief complaints of flushing, headache, nausea, and joint pain. He had consumed 800 g of grilled ocean perch liver the day before and had experienced numbness shortly after. Although physical examination revealed only facial flushing, we suspected acute vitamin A intoxication due to his diet history. On day 2 after ingestion, his serum retinol levels were elevated at 1577 ng/mL, which confirmed vitamin A intoxication. He returned for follow-up on day 4 after ingestion, by which time his presenting symptoms had improved, but he had developed desquamation of his facial skin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should consider acute vitamin A intoxication in the differential diagnosis of patients with headache, flushing, desquamation, nausea, and vomiting of unknown etiology. Complete diet histories and checking vitamin A levels are essential for diagnosis. This report highlights the diagnostic difficulties associated with vitamin A intoxication and the importance of an accurate diet history.
authors: Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba, Japan.
authors: Yosuke
authors: Y
authors: Homma
authors: Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
authors: Norio
authors: N
authors: Otani
authors: Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
authors: Shinichi
authors: S
authors: Ishimatsu
mesh_terms: D000328:Adult; D000818:Animals; D004435:Eating; D005517:Foodborne Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006986:Hypervitaminosis A / Q000175:diagnosis / Q000209:etiology*; D008099:Liver; D008297:Male; D010471:Perches
keywords: acute intoxication; desquamation; facial flushing; natural toxins; poisoning; retinol; toxicology; vitamin A