Giffen Mark A, McLemore Jerri L
Acad Forensic Pathol. 2019 Mar;9(1-2):118-126. doi: 10.1177/1925362119851129. Epub 2019 Sep 6.
Vitamin C (ascorbic acid) has long been known to have antioxidant properties, with associated claims that it can boost the immune system, fight off infection, and help in the treatment of cancer. Similar to many other over-the-counter and herbal medicines, vitamin C can cause potential side effects with significant morbidity and rarely mortality. We discuss a case of an elderly woman with metastatic adenocarcinoma of the lung that was treated with several rounds of allopathic chemotherapy; however, treatment was stopped because of worsening quality of life and disease progression. She was treated with 10 courses of intravenous high-dose vitamin C at a local homeopathic medical center as an alternative treatment method. Five days after the last vitamin C administration, she was admitted to an allopathic hospital due to acute renal failure and oliguria culminating in a myocardial infarct due to underlying atherosclerotic disease. Workup revealed dehydration secondary to poor oral intake and acute renal failure which was clinically concerning for calcium oxalate- induced kidney injury. At the time of autopsy, in addition to her widely metastatic adenocarcinoma and myocardial damage, hyperoxalosis of the kidney with acute kidney injury was present. Hyperoxalosis of the kidney is a documented phenomenon related to administration of intravenous and oral vitamin C at superphysiologic doses as recommended by some natural and homeopathic practitioners and is, therefore, a significant complication of treatment. This case highlights the renal complications of supertherapeutic vitamin C administration and the associated morbidity which can contribute to death.
长期以来，人们都知道维生素C（抗坏血酸）具有抗氧化特性，并有说法称它能增强免疫系统、抵御感染并有助于癌症治疗。与许多其他非处方和草药药物类似，维生素C可能会导致潜在的副作用，严重时会引发疾病，甚至导致死亡。我们讨论了一例患有肺转移性腺癌的老年女性病例，她接受了多轮常规化疗；然而，由于生活质量恶化和疾病进展，治疗被迫停止。作为一种替代治疗方法，她在当地一家顺势疗法医疗中心接受了10个疗程的静脉高剂量维生素C治疗。在最后一次服用维生素C五天后，她因急性肾衰竭和少尿被收治到一家常规医院，最终因潜在的动脉粥样硬化疾病引发心肌梗死。检查发现，由于口服摄入不足导致脱水以及急性肾衰竭，临床上怀疑是草酸钙引起的肾损伤。尸检时，除了广泛转移的腺癌和心肌损伤外，还发现了伴有急性肾损伤的肾脏高草酸血症。肾脏高草酸血症是一种已被记录的现象，与一些自然疗法和顺势疗法从业者推荐的超生理剂量静脉和口服维生素C的使用有关，因此是治疗的一种严重并发症。该病例突出了超治疗剂量维生素C给药的肾脏并发症以及可能导致死亡的相关发病率。
