EJMCR. 2020; 4(2): 49-51

Intravascular hemolysis and methemoglobinemia from high dose vitamin C

Authors: Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell.

ABSTRACT

Background: Vitamin C is often used by complementary and alternative medicine practitioners for its antioxidant properties. We describe a case of severe hemolytic anemia and methemoglobinemia paradoxically resulting from an oxidative stress of high dose vitamin C in a patient with previously undiagnosed glucose-6-phosphate dehydrogenase (G6PD) deficiency. Case Presentation: A 47-year-old man presented with severe hemolytic anemia and methemoglobinemia days after receiving 395 g of intravenous (IV) vitamin C at an alternative medicine practice. He was managed conservatively with transfusions and his hemolysis subsided after several days. His G6PD level, measured months after his presentation, was deficient at 0.4 units/g. Conclusion: While vitamin C is often considered an antioxidant, its utilization in tissues produces its oxidized form (dehydroascorbic acid) which depletes intra-erythrocyte stores of glutathione. Patients with G6PD deficiency have reduced abilities to restore intracellular glutathione, placing them at risk for oxidative stress, and subsequent hemolysis that can be life threatening.

Keywords:
Case report, hemolysis, methemoglobinemia, vitamin C, glucose-6-phosphate dehydrogenase deficiency


View PDF
Intravascular hemolysis and methemoglobinemia from high dose vitamin C


Authors
Ryan K Nelson
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States of America
PubMed articlesGoogle scholar articles

Janet Ma
Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
PubMed articlesGoogle scholar articles

Niloofar Latifi
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
PubMed articlesGoogle scholar articles

Rebecca E Sell
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States of America
PubMed articlesGoogle scholar articles


Correspondence to:
. Rebecca E. Sell, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA.; rsell@ucsd.edu

Publication history
Received 06 Dec 2018
Accepted 10 Dec 2019
Published online 06 Mar 2020
Published in print 12 Mar 2020

How to cite this article?

Export to EndNote Export to refMan

Pubmed Style

Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. 2020; 4(2): 49-51. doi:10.24911/ejmcr/173-1544044604


Web Style

Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. https://www.ejmcr.com/?mno=20402 [Access: June 04, 2020]. doi:10.24911/ejmcr/173-1544044604


AMA (American Medical Association) Style

Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. 2020; 4(2): 49-51. doi:10.24911/ejmcr/173-1544044604


Vancouver/ICMJE Style

Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. (2020), [cited June 04, 2020]; 4(2): 49-51. doi:10.24911/ejmcr/173-1544044604


Harvard Style

Nelson, R. K., Ma, . J., Latifi, . N. & Sell, . R. E. (2020) Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR, 4 (2), 49-51. doi:10.24911/ejmcr/173-1544044604


Turabian Style

Nelson, Ryan K., Janet Ma, Niloofar Latifi, and Rebecca E. Sell. 2020. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. European Journal of Medical Case Reports, 4 (2), 49-51. doi:10.24911/ejmcr/173-1544044604


Chicago Style

Nelson, Ryan K., Janet Ma, Niloofar Latifi, and Rebecca E. Sell. "Intravascular hemolysis and methemoglobinemia from high dose vitamin C." European Journal of Medical Case Reports 4 (2020), 49-51. doi:10.24911/ejmcr/173-1544044604


MLA (The Modern Language Association) Style

Nelson, Ryan K., Janet Ma, Niloofar Latifi, and Rebecca E. Sell. "Intravascular hemolysis and methemoglobinemia from high dose vitamin C." European Journal of Medical Case Reports 4.2 (2020), 49-51. Print. doi:10.24911/ejmcr/173-1544044604


APA (American Psychological Association) Style

Nelson, R. K., Ma, . J., Latifi, . N. & Sell, . R. E. (2020) Intravascular hemolysis and methemoglobinemia from high dose vitamin C. European Journal of Medical Case Reports, 4 (2), 49-51. doi:10.24911/ejmcr/173-1544044604


Share this article

Click the icon of the social media platform on which you would like to share this article.

Article Statistics

Request permissions

If you wish to reuse any part or all of this article please contact the copyright holder, contact@ejmcr.com.

Copyright © 2018 Discover Publishing Group. All Rights Reserved.