Abstract Details

Title Pyridoxine-Containing Nutritional or “Natural” Supplements: A Potential Cause of Worsening Neuropathy Symptoms

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-011

Objective To raise awareness among clinicians about the possibility of worsening neuropathy symptoms from unintended consumption of high doses of pyridoxine included in nutritional or “natural” supplements.

Background Patients with pre-existing neuropathies are more susceptible to de novo or worsening neuropathy symptoms due to toxic insults. Pyridoxine ingestion is recognized as a cause of sensory neuropathy and could worsen the symptoms in these patients.

Design/Methods We reviewed the clinical records and ancillary tests from patients seen at the clinic who presented with de novo or worsening pre-existing neuropathy symptoms and elevated plasma pyridoxine levels. The source of pyridoxine ingestion was identified and the patient’s clinical response to stopping the supplementation was evaluated. An expanded assessment of the pyridoxine content in nutritional or “natural” supplements available for sale in our community was performed.

Results Four patients aged 71.8 to 62.1 years were identified. Two were male and 2 were female. All patients had pyridoxine levels above the normal levels (1.3 to 7.8 times the upper limit of normal). All showed improvement in sensory symptoms upon discontinuation of the supplement. We also identified 36 nutritional/natural supplements with pyridoxine HCL concentrations that ranged from 1.3 to 100 mg per single unit, with total recommended dosages ranging from 2.6 mg to 240 mg daily.

Conclusions Unintended consumption of pyridoxine-containing supplements may represent not only the cause, but the explanation of worsening neuropathy symptoms in patients with pre-existing neuropathy. Clinicians should be aware that many mixed-ingredient nutritional or "natural" supplements contain high doses of pyridoxine.

Authors/Disclosures
Miguel A. Santiago-Cruz (UIC Neurology & Rehabilitation, MC 796) PRESENTER	No disclosure on file
Janice Vargas, MD	Dr. Vargas has nothing to disclose.
Lizmarie Tirado-Castro	No disclosure on file
Sonia M. Caraballo-Cartagena, MD (Advocate Health Care)	Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Takeda. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alnylam. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx.
Carlos A. Luciano, MD, FAAN (University of Puerto Rico School of Medicine)	Dr. Luciano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Luciano has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for SIMED. Dr. Luciano has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Vazquez-Irizarry Law Office. The institution of Dr. Luciano has received research support from National Institutes of Health. Dr. Luciano has received personal compensation in the range of $100,000-$499,999 for serving as a Professor and Chair with University of Puerto Rico.

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