BMJ Case Reports 2017; doi:10.1136/bcr-2017-221718
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Severe liver injury due to Epsom salt naturopathy

Press Release
  1. Philip Augustine4
  1. 1 Department of Hepatology and Transplant Medicine, PVS Memorial Hospital Ltd, Cochin, Kerala, India
  2. 2 Department of Pathology, PVS Memorial Hospital Ltd, Cochin, Kerala, India
  3. 3 Department of Pathology, Lakeshore Hospital and Research Centre Ltd, Cochin, Kerala, India
  4. 4 Department of Gastroenterology, PVS Memorial Hospital Ltd, Cochin, Kerala, India
  1. Correspondence to Dr Cyriac Abby Philips, abbyphilips{at}
  • Accepted 8 August 2017
  • Published 2 October 2017


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), …

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