Can your child overdose on cod liver oil?

Photo Credit: ifood.tv/blog 

I had to ask that question today.  Let me start by telling you that they will be fine. While I was making lunch today, the seven-year-old grabbed my arm and said he had found the three little girls in the basement pantry eating a bottle of cod liver oil capsules. My stomach lurched. I was worried that I or one of the older children had left the door unlocked to the room where we keep storage containers of dry goods and bulk vitamins but the four-year-old and six-year-old admitted to cooperatively opening it and the four-year-old opened and passed around the cod liver oil. It may have been an extension of the hospital game they have been playing. Cod liver oil has been shown to reduce respiratory infections in children (see HERE) and we take it daily but now I was worried that my children had inadvertently harmed themselves. The brand new bottle was supposed to contain 250 capsules, so I went into another room and counted all that were left, then I counted them again. A total of 59 capsules were missing.

As it turns out, that wasn't a problem. If each of the girls had consumed that much by themselves, it still would not be a problem. The registered nurse at The Rocky Mountain Poison and Drug Center said that they only refer patients to the hospital for treatment for one-time dosages exceeding 300,000iu of vitamin A. My capsules contained 1,250iu each meaning that each girl could have consumed not just the missing 59 capsules but the whole bottle before risking acute toxicity. THIS source indicated that the threshold of toxicity is 25,000iu /kg of body weight. So how do you do the math to determine if you child is at risk?

First, my local poison control refers patients to hospital treatment after massive dose of 300,000iu. Look on your bottle, does it say how many international units (or iu) in each capsule or per serving? If it says per serving, divide the number of iu by the number of capsules in each serving. Multiply this by the number of possible capsules taken. If that number is less than 300, 000 then you are likely alright but might want to double check with your own physician or local poison control.

Example: my bottle contains 1250iu per capsule. Each girl had to have taken less than 59 but since that is the maximum that each could take I multiply 59 * 1250= 73,730. This amount is well under the 300, 000 guideline of my local poison control. No one is in any danger here.

Second, you can do the math to see what the number of capsules your child would have to take to get 25,000iu per kilogram of body weight. Once you know how many iu in each capsule, you'll need to weigh the child. If you are using pounds to weigh your child, then divide their weight by 2.2 (or type it into Google like this: 30lb in kg). Then multiply this number by 25,000 to see what that child's threshold is based on weight. Then take that threshold and divide it by the number of iu in each capsule. That is the number the child would have to take in order for the local poison control to send to the hospital.

Example: My two-year-old weighs 30 pounds. I divide that by 2.2 and I get 13.6. Cristina weighs 13.6kg so I multiple this by 25,000 to get a toxicity threshold of 325,000iu which is very close to the protocol of the poison control center. I divide the 325,000 by 1250 (the iu in each capsule) to get the total number of capsules that might represent a danger which is 260 capsules.

The smallest of the three of them would have to take more than the total number of capsules in that bottle to be sent to the hospital. In fact, the six year old would have to take almost two bottles worth (a total of 440 capsules in all) to reach the 25,000iu/kg level. The registered  nurse at the poison control center said it is far more likely for him to see cases of slow building toxicity from long term exposure to high level rather than a one time high dose over dose. According to the same reference above, found HERE, that long term daily threshold is 25,000iu daily. In the case of my specific brand of cod liver oil, that is a grand total of 20. So as long as we stay under the 20 pills a day level, we should be good.

I feel better about my cod liver oil and the risk of toxicity from vitamin A, a fat soluble vitamin which is stored in the body for later use. So the next time some fear monger tells you that you are slowly poisoning your children with vitamin A, you can assure them that you did the math and cod liver oil is the right answer.

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