Article Text

Download PDFPDF

Severe liver injury due to Epsom salt naturopathy
  1. Cyriac Abby Philips1,
  2. Rajaguru Paramaguru2,
  3. Pushpa Mahadevan3,
  4. 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}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


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), …

View Full Text


  • Contributors CAP wrote the manuscript. RP and PM provided pertinent images and revised the manuscript. PA provided critical revisions and is the primary physician caring for the patient. All authors approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.