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
Article Info
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
