TY - JOUR T1 - Severe liver injury due to Epsom salt naturopathy JF - BMJ Case Reports DO - 10.1136/bcr-2017-221718 VL - 2017 SP - bcr-2017-221718 AU - Cyriac Abby Philips AU - Rajaguru Paramaguru AU - Pushpa Mahadevan AU - Philip Augustine Y1 - 2017/10/04 UR - http://casereports.bmj.com/content/2017/bcr-2017-221718.abstract N2 - 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), … ER -