https://doi.org/10.4081/gc.2022.10286

Methemoglobinemia and acute hemolysis induced by high intravenous doses of vitamin C in a COVID-19 patient with unrecognized glucose-6- phosphate-dehydrogenase deficiency

Vol. 8 No. 2 (2022)
Submitted: 16 November 2021
Accepted: 8 July 2022
Published: 25 July 2022
COVID-19, glucose-6-phosphatedehydrogenase deficiency, methemoglobinemia, hemolytic anemia, vitamin C.
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Authors

Filippo Luca Fimognari
filippo.fimognari@virgilio.it
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Valentina Bambara
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Paola Scarpino
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Olga Cuccurullo
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Roberto Ricchio
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Claudio Iorio
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.
Massimo Rizzo
Unit of Geriatrics, Department of Medicine, Azienda Ospedaliera ‘Annunziata - Mariano Santo - S. Barbara’, Cosenza, Italy.

In glucose-6-phosphate-dehydrogenase deficiency (favism), exposure to oxidant agents can trigger hemolytic crises. The intravenous administration of very high doses of vitamin C was proposed as a treatment for severe coronavirus disease 2019 (COVID-19) pneumonia. Unlike low vitamin C doses, very high doses (>6 gr daily) can promote H2O2 formation, oxidation of hemoglobin to methemoglobin and, eventually, hemolytic anemia in patients with favism. We here describe the case of a 77-year old man hospitalized for severe COVID-19 pneumonia and treated with a mean daily dose of 9.5 gr of intravenous vitamin C during the first 6 days. He developed methemoglobinemia and hemolytic anemia, which improved after interruption of vitamin C treatment. Previously unrecognized glucose- 6-phophate-dehydrogenase deficiency was diagnosed. This first case of vitamin Cinduced hemolytic anemia in a COVID-19 patient indicates the need of a screening for glucose-6-phosphate-dehydrogenase deficiency before treatment with very high vitamin C doses or for long period.

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How to Cite

Fimognari, F. L., Bambara, V., Scarpino, P., Cuccurullo, O., Ricchio, R., Iorio, C., & Rizzo, M. (2022). Methemoglobinemia and acute hemolysis induced by high intravenous doses of vitamin C in a COVID-19 patient with unrecognized glucose-6- phosphate-dehydrogenase deficiency. Geriatric Care, 8(2). https://doi.org/10.4081/gc.2022.10286

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