At what stage of the neuropathy workup do you screen for B6 toxicity?

In my experience, vitamin B6 deficiency due to poor oral intake is very uncommon. However, toxicity may occur with supplementation typically more than 2 gm/day, although chronic use of 50 mg/d may also be a cause.

Vitamin B6 is present in many supplements and toxicity may cause direct damage to the dorsal root ganglia sensory neurons. The presentation is that of a ganglionopathy, which may worsen for weeks, even after discontinuation.

My approach is to elicit a history of supplement consumption. If that is the case, then I include a serum B6 level in the work up. It is not surprising to find patients with multiple possible causes of peripheral neuropathy. I just saw a patient in the office this morning with pre-diabetes, but because he was...

I’ve found that many of my younger patients who present with B6 toxicity get it from the overuse of certain energy drinks. For instance, a single shot of a 5-hour energy drink has about 2000% of your daily recommended value of B6.