Severe liver injury due to Epsom salt naturopathy

Description

A 38-year-old non-alcoholic, non-diabetic man with gallstone disease was prescribed three tablespoons of Epsom salt (magnesium sulfate crystals) with lukewarm water for 15 days for 'stone dissolution' by a naturopathy practitioner. He developed loss of appetite and darkening of urine from the 12th day on treatment and jaundice from the second day after treatment completion. The patient denied fevers, skin rash, joint pains, myalgia, abdominal pain, abdominal distension and cholestatic symptoms. Examination revealed a deeply icteric patient oriented to time, place and person without organomegaly or stigmata of chronic liver disease. Blood investigations revealed platelet count 190 (normal 150–450 x 10⁹/L), total bilirubin 12.8 (39.3 mmol/L) (normal 0.3–1.0 mg/dL or 5.0–17.0 mmol/L), direct bilirubin 6.9 (21.7 mmol/L) (0.0–0.2 mg/dL or 0.0–3.4 mmol/L), aspartate aminotransferase 508 (<37 U/L), alanine aminotransferase 228 (<41 U/L), -glutamyltransferase 298 (5–61 U/L), alkaline phosphatase 178 (35–129 U/L), albumin 4.2 (3.5–5.0 g/dL) and international normalised ratio 1.1 (0.9–1.2). R ratio was 3.84 and Roussel Uclaf...

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