Vitamin C-induced Hemolysis: Meta-summary and Review of Literature

Vitamin C is increasingly being used, and even high doses are considered safe. However, complications including hemolysis have been reported. We performed a systematic search from PubMed, Science Direct, and Google Scholar databases from January 1975 till July 31, 2021. Search terms used were "Vitamin C" OR "ascorbic acid" AND "haemolysis" OR "haemolytic anaemia." Data regarding patient's demographics, outcomes and dose, duration, and form of vitamin C were extracted. Fourteen case reports matched the selected criteria, with age ranging from 3 weeks to 75 years with 78.6% being males. About 71.4% were diagnosed to have glucose-6-phosphate dehydrogenase (G6PD) deficiency but previous hemolysis was reported in only two patients, and 57.1% were prescribed vitamin C for nutritional supplementation. The dose ranged from 1 to 200 g/day with 57.1% receiving intravenous formulations. Half of these patients developed other complications including acute kidney injury (AKI), disseminated intravascular coagulation, oxalosis, and methemoglobinemia. About 78.6% developed complications within 3 days of starting vitamin C and only one death was reported. Vitamin C is generally a safe drug but it should be prescribed with caution and only when benefits outweigh the risks. Physicians should be aware of potential complications like severe hemolysis and AKI, especially when using high doses and in G6PD deficiency.

HOW TO CITE THIS ARTICLE

Juneja D, Jain R, Nasa P. Vitamin C-induced Hemolysis: Meta-summary and Review of Literature. Indian J Crit Care Med 2022;26(2):224-227.

Hong Kong Poison Information Centre: Annual report 2019

Background:

The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005.

Objective:

To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019.

Methods:

This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019.

Results:

A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report.

Conclusion:

This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.

Treatment strategies for glucose-6-phosphate dehydrogenase deficiency: past and future perspectives

Glucose-6-phosphate dehydrogenase (G6PD) maintains redox balance in a variety of cell types and is essential for erythrocyte resistance to oxidative stress. G6PD deficiency, caused by mutations in the G6PD gene, is present in ~400 million people worldwide, and can cause acute hemolytic anemia. Currently, there are no therapeutics for G6PD deficiency. We discuss the role of G6PD in hemolytic and nonhemolytic disorders, treatment strategies attempted over the years, and potential reasons for their failure. We also discuss potential pharmacological pathways, including glutathione (GSH) metabolism, compensatory NADPH production routes, transcriptional upregulation of the G6PD gene, highlighting potential drug targets. The needs and opportunities described here may motivate the development of a therapeutic for hematological and other chronic diseases associated with G6PD deficiency.