title: If vitamins could kill: massive hemolysis following naturopathic vitamin infusion.
abstract: BACKGROUND
  Hemolysis from naturopathic remedies remains poorly reported in the medical literature, although it is most commonly noted in the patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency. We report a case of massive intravascular hemolysis following the infusion of a naturopathic preparation that contains vitamins.
  
  
  METHODS
  A 47-year-old African-American man presented to the hospital with 3 days of fever, dyspnea, emesis, dark urine, and progressive confusion. His symptoms began 1 day following an infusion of a vitamin complex. His physical examination was significant for lethargy and scleral icterus. Initial laboratory studies were notable for anemia (hemoglobin, 3.3 g/dL and hematocrit, 11%), brisk reticulocytosis (33%), acute renal insufficiency (creatinine, 2.8 mg/dL), and indirect hyperbilirubinemia (total bilirubin, 4.4 mg/dL). His peripheral smear demonstrated "blister cells," erythrocytes that have been left devoid of precipitated hemoglobin by the spleen, which are commonly seen in patients with G6PD deficiency. His physician revealed that the infusion contained vitamins B and D complex, free amino acids, magnesium, and taurine. The patient clinically improved and was discharged to home. G6PD concentration was significantly reduced to 4.7 U/g Hb upon recovery.
  
  
  CONCLUSIONS
  Life-threatening intravascular hemolysis may occur following a naturopathic vitamin infusion and may identify previously unknown G6PD deficiency. Since most properly formulated naturopathic treatments have few toxic ingredients, the possibilities of improper formulation, toxic diluents, or contaminants should be considered. Inadequate regulatory oversight of naturopathic remedies has the potential to allow serious toxicity especially in genetically predisposed individuals.
authors.affiliation: The New York City Poison Control Center, New York, NY 10016, USA. doczhanna@gmail.com
authors.forename: Zhanna
authors.initials: Z
authors.lastname: Livshits
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Hymes
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D001772:Blood Cell Count; D004910:Erythrocyte Membrane / Q000201:enzymology; D004912:Erythrocytes / Q000473:pathology; D005954:Glucosephosphate Dehydrogenase / Q000097:blood; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications; D006439:Hemodynamics; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009324:Naturopathy; D014815:Vitamins / Q000506:poisoning*
chemical_list: D014815:Vitamins; D005954:Glucosephosphate Dehydrogenase