EJMCR |

Case Report

Volume: 4 | Issue: 2 | Published: Mar 06, 2020 | Pages: 49 - 51 | DOI: 10.24911/ejmcr/173-1544044604

Intravascular hemolysis and methemoglobinemia from high dose vitamin C

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

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

Janet Ma

Department of Medicine, University of California San Diego, La Jolla, CA, United States of America

Niloofar Latifi

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America

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

Publication History

Received: December 06, 2018

Accepted: December 10, 2019

Published: March 06, 2020

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, green

Pubmed Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. 2020; 06 (March 2020): 49-51. doi:10.24911/ejmcr/173-1544044604

Web Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. https://ejmcr.com/articles/1451 [Access: December 25, 2024]. doi:10.24911/ejmcr/173-1544044604

AMA (American Medical Association) Style

Vancouver/ICMJE Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell. Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR. (2020), [cited December 25, 2024]; 06 (March 2020): 49-51. doi:10.24911/ejmcr/173-1544044604

Harvard Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell (2020) Intravascular hemolysis and methemoglobinemia from high dose vitamin C. EJMCR, 06 (March 2020): 49-51. doi:10.24911/ejmcr/173-1544044604

Chicago Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell. "Intravascular hemolysis and methemoglobinemia from high dose vitamin C." 06 (2020), 49-51. doi:10.24911/ejmcr/173-1544044604

MLA (The Modern Language Association) Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell. "Intravascular hemolysis and methemoglobinemia from high dose vitamin C." 06.March 2020 (2020), 49-51. Print. doi:10.24911/ejmcr/173-1544044604

APA (American Psychological Association) Style

Ryan K. Nelson, Janet Ma, Niloofar Latifi, Rebecca E. Sell (2020) Intravascular hemolysis and methemoglobinemia from high dose vitamin C. , 06 (March 2020), 49-51. doi:10.24911/ejmcr/173-1544044604