Vitamin C has been used as an alternate reducing agent for methemoglobinemia in individuals with G6PD deficiency. What hematologic complication may arise from the use of high dose vitamin C?
An elderly female received a 30 g intravenous dose of vitamin C as a therapy for hemifacial spasm. She presented to an ED several days later with pallor, jaundice and dyspnea. She had a Hgb of 6.3 g/dL with an elevated LDH, depressed haptoglobin and a Methgb of 8.3%. Subsequent testing after recovery revealed moderate severity G6PD deficiency (2.16 IU/g Hb [reference 6.35–10.33]).
Lo YH et al. High dose vitamin C induced methemoglobinemia and hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency. Am J Emerg Med. 2020 Nov;38(11):2488.e3-2488.e5. doi: 10.1016/j.ajem.2020.05.099.
Submitted by: Michael Hodgman, MD on behalf of Herbals and Dietary Supplements Section