Intravascular hemolysis and methemoglobinemia from high dose vitamin C
Authors: Ryan K Nelson, Janet Ma, Niloofar Latifi, Rebecca E Sell
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
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
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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
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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
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
Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. https://www.ejmcr.com/?mno=20402 [Access: April 23, 2024]. doi:
10.24911/ejmcr/173-1544044604
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
Nelson RK, Ma J, Latifi N, Sell RE. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. (2020), [cited April 23, 2024]; 4(2): 49-51. doi:
10.24911/ejmcr/173-1544044604
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
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
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
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
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