A woman of age 34 yrs has been taking large quantities of vitamins in hope that it would prevent many infections & cancers. Now she came with complaint of sleep disturbances, increased hair fall, anorexia, nausea, fissures & dryness of lips. What is the most likely cause of these symptoms?

Only fat-soluble vitamins can cause toxicity as they can be stored in the body. Given clinical features - sleep disturbances, hair loss, anorexia, nausea, skin desquamation are suggestive of Vitamin-A toxicity. Enlarged liver & papilloedema can also be seen in chronic Vit-A intoxication. High doses are teratogenic. Vitamin-D toxicity can cause hypercalcemia which results in anorexia, nausea, vomiting, thirst & drowsiness. The patient may lapse into coma, while cardiac arrhythmias & renal failure may occur.