Abstract
Background
Alpha lipoic acid (ALA) is an anti-oxidant found in many over-the-counter supplements
and is used in treatments for diabetes, hypertension, and obesity. Although it is
a safe oral molecule, there have been eight cases of ALA toxicity reported. Three
reported cases were among adult patients and five were among pediatric patients. A
14-year-old girl died after ingestion of 6 g of ALA led to multi-organ failure.
Case Report
A 42-year-old woman presented to the emergency department 4 h after an intentional
overdose of 10 tablets of ALA 600 mg each (6 g, 92.3 mg/kg). She developed refractory
seizures, metabolic acidosis, thrombocytopenia, rhabdomyolysis, depressed cardiac
contractility, kidney injury, and supraventricular tachycardia. Her condition deteriorated
and she developed multi-organ failure. The patient was started on dual pressors, anti-epileptic
medications, high-dose insulin and euglycemia protocol, and methylene blue (1 mg/kg).
Despite aggressive resuscitation, she required intubation and died. Why Should an
Emergency Physician Be Aware of This? This was the ninth case and the first reported
adult mortality from ALA toxicity with multi-organ failure. Our case shared some similar
findings with previously reported cases, including refractory seizures, metabolic
acidosis, thrombocytopenia, and rhabdomyolysis. Refractory supraventricular tachycardia
and severe agitation have not been reported with ALA toxicity previously. The range
of toxicity of ALA is not well established. A reported dose of 6 g caused death in
a pediatric patient as well as our patient, but others survived doses of 6 g and 18
g. Toxicologists and emergency physicians should be prepared for clinical deterioration
and consider aggressive resuscitation in severe ALA toxicity.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential.Biochim Biophys Acta. 2009; 1790: 1149-1160
- Adverse effects of high doses of intravenous alpha lipoic acid on liver mitochondria.Glob Adv Health Med. 2014; 3: 25-27
- Safety evaluation of α-lipoic acid (ALA).Regul Toxicol Pharmacol. 2006; 46: 29-41
- Lipoic acid-the drug of the future.Pharmacol Rep. 2005; 57: 570-577
- Alpha-lipoic acid supplement in obesity treatment: a systematic review and meta-analysis of clinical trials.Clin Nutr. 2018; 37: 419-428
- Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% α-lipoic acid related to photoageing of facial skin.Br J Dermatol. 2003; 149: 841-849
- Alpha lipoic acid intoxicatıon: an adult.Am J Emerg Med. 2018; 36 (.e3–5): 1125
- First description of the alpha lipoic acid intoxication in an adult patient worldwide following oral administration.Am J Emerg Med. 2018; 36 (e5–6): 1126
- Fatal non-accidental alpha-lipoic acid intoxication in an adolescent girl.Klin Pädiatr. 2014; 226: 292-294
- Neuroprotection by the metabolic antioxidant α-lipoic acid.Free Radic Biol Med. 1997; 22: 359-378
- Alpha lipoic acid intoxication in a 10 months old infant; a case report.Anatol J Clin Investig. 2012; 6: 267-268
- Alpha lipoic acid intoxication, treatment and outcome.Clin Toxicol. 2013; 51: 522
- A rare cause of status epilepticus; alpha lipoic acid intoxication, case report and review of the literature.Eur J Pediatr Neurol. 2015; 19: 730-732
- Alpha-lipoic acid intoxication in an adolescent girl: case report and review of the literature.Turk Arch Pediat. 2020; 55: 328
- Multiple organ failure and shock following acute alpha lipoic acid (ALA) intoxication.Clin Toxicol. 2019; 57: 749-751
- Pharmacokinetics of alpha-lipoic acid in subjects with severe kidney damage and end-stage renal disease.J Clin Pharmacol. 2005; 45: 313-328
Article info
Publication history
Published online: December 21, 2022
Accepted:
December 13,
2022
Received in revised form:
August 1,
2022
Received:
June 3,
2022
Publication stage
In Press Uncorrected ProofFootnotes
RECEIVED: 3 June 2022; FINAL SUBMISSION RECEIVED: 1 August 2022; ACCEPTED: 13 December 2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.