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DOI:
CASEREPORT
Acutekidneyinjurysecondarytochlorinedioxideuse
forCOVID-19prevention
ErnestoMedina-Avitia1|PamelaTella-Vega2|ChristianGarcía-Estrada1
1InternalMedicineDepartment,General
Hospital“SantiagoRamonyCajal”Abstract
ISSSTEDurango,Durango,MexicoChlorinedioxidehasbeenhistoricallyusedasadisinfectingagentfor
2
Research,NationalInstituteofGeriatrics,
MexicoCity,MexicooptionforpreventionandtreatmentofCOVID-19hasemergedduetoa
-year-oldmalewho
Correspondencedevelopedacutekidneyinjuryanddisseminatedintravascularcoagulation
ChristianGarcía-Estrada,Internal
MedicineDepartment,GeneralHospitalafterchlorinedioxideprophylacticingestion,withregressionaftertherapy
“SantiagoRamonyCajal”ISSSTEwithhemodialysis.
Durango,PredioCanoas,Durango,
Email:christianalan.******@,chlorinedioxide,COVID-19,hemodialysis
INTRODUCTIONaspreventionforCOVID-19andafter5dayshedevel-
opednausea,vomiting,andalteredmentalstate;no
Chlorinedioxidehasbeenhistoricallyusedasafever,dyspnea,
adramaticimpactontheincidenceofcholera,dysentery,-upreportedglucoseof
andtyphoidfeverdisseminationthoroughthe70sand640mg/,bloodureaof
–
,antimi-236mg/dl,,totalleucocyte
crobialapplications,reducingloadsofadsorbableorganiccounts4100/mm3,andplateletcount36,000/mm3,ele-
4
(PT),INR(),andD-dimer
theemergenceofsevereacuterespiratorysyndromecoro-(),consistentwiththediagnosisofdissemi-
navirus2(SARS-Cov-2)pandemic,chlorinedioxidehasnatedintravascularcoagulation(DIC).Peripheralsmear
comeintowidespreaduseasapotentialtreatmentorpre-wasnormal,methemoglobinlevelswerenotavailable.
ventionoptiondespitetheabsenceofevidenceregardingMetabolicacidosiswithsecondaryrespiratoryalkalosis
,-
presentingwithacutekidneyinjury(AKI)duetochlo-rayandbrainCT--
-
tationandprogressedtoanuriadespiteintravenous
CASEPRESENTATIONsessionofhemodialysis(HD)withdecreasedserumcre-
atinineto1mg/dlandbloodureato73mg/dl,aswellas
A55-year-oldmalewithaclinicalhistoryofhyperten--
sionandtype2diabetesattendedtheemergencyletcountwas100,000/
,andhewasdischargedafter6daysofhospitaliza-
Thepatientdecidedingestionofanonspecifieddilutiontion(Figure1).
;1–©
2MEDINA-AVITIAETAL.
FIGURE1Serumcreatinineand
bloodureaovertime[Colorfigurecan
]
TABLE1Literaturereportedcaseschlorinecompoundpoisoning
AgeChlorine
ReferencesGender(years)compoundDoseClinicalfindingsNotes
13M25Sodium10gAlteredmentalstatusmHB56%,acutetubulointerstitial
chloritenephritisonkidneybiopsy.
Completerecoveryofrenal
function.
14M42Sodium27gAbdominalpain,
.
hypotension
dioxideshowedfeaturesofATN.
16M65SodiumNANausea,vomiting,diarrhea,,,mHB
%.Developedhemolysis;
receivedCVVH.
17M45Sodium100mlCyanotic,loweredconsciousness,Hemolyticanemia,DIC,
chloritevomitingandincontinencebronchopneumoniaand
sepsis,mHB40%.Received16
HDsessions.
Abbreviations:ATN,acutetubularnecrosis;CVVH,continuousvenovenoushemofiltration;DIC,disseminatedintravascularcoagulopathy;HD,hemodialysis;
mHB,methemoglobin;NA,notavailable;SC:serumcreatinine.
DISCUSSIONmanyoff-labelalternativetherapies,despitethelackof
,theFDA
Chlorinedioxideisaveryattractivealternativeasadisinfec-issuedawarningletteragainstsellingchlorinedioxideprod-
tant:itspropertiesareequivalenttoorevenexceedthoseofuctstotreatorpreventCOVID-
,theFederalCommissionsfortheProtection
odorproblemsthatresultfromchloridetreatmentduetoitsagainstSanitaryRisks(COFEPRIS)alsostateditsposture
lackofreactionwithphenol,
SARS-Cov-2pandemic,theabsenceofaspecificandchlorinedioxide,butsomeimportantsideeffectshave
CHLORINEDIOXIDEINTOXICATION3
decreasedredbloodcellcounts,half-lifeoferythrocytes,therapiesforpreventionandtreatmentofthisinfection.
hemoglobin(HB)concentrations,andpackedcellvolumeThemainriskofthispracticeisthelackofevidence
at30and60daysofexposuretodrinkingwater,atconcen-regardingsafetyandefficacyofthese“natural”com-
–
trationsrangingfrom1toashighas1000mg/
authorshavereportedtheabilityofchlorite(ClO2À)tooxi-,emergingsideeffectsareexpected
dizeHBtomethemoglobin(mHB),10whichinturndepletesandphysiciansmustbeawareofthesecomplications.
glutathioneconcentration(anantioxidantmechanism),ThiscaseillustratesAKIandDICafterchloridedioxide
increasingthelevelsofhydrogenperoxide(HP).Thisoxida-intoxication.
tivestressisthemainmechanismcausinglipidperoxida-
–
tion,intravascularhemolysis,
addition,itwasobservedthatchlorite(ClO2À)andchlorateAllauthorsdeclarenocompetinginterestsorexternal
(ClO3À).
sideeffectsincludegastrointestinalsymptoms(gastric
mucosarepresentsthefirstbarrierdefensemechanism)ETHICALSTATEMENT
suchasnausea,vomiting,-Thisarticledoesnotcontainanystudieswithhuman
larhemolysis13andacutemyocardialdamagehavealsoparticipantsoranimalsperformedbyanyofthe
Regardingkidneyinjury,onlycasereportsofchloride-
.
reportedthecaseofa25-year-oldmalewhodevelopedAKI
aftersodiumchloritepoisoningwithfeaturesofacuteORCID
tubulointerstitialnephritisonkidneybiopsy,andcompleteChristianGarcía-Estrada-0002-
15
-0567
sodiumchloratepoisoningina45-year-oldmalewithAKI
ofacutetubularnecrosisonrenalbiopsyofa20-year-oldREFERENCES
,.
17
;11:42–62.
a55-year-,Abdel-RahmanMS,
<100mlof28%sodiumchlorite;thepatientdevelopedchlorinedioxide,-
–
hemolyticanemiaandDIC,;46:137.
bloodcelltransfusionandintermittenthemodialysis,
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.,GuionC,
resumesreportedcasesofAKIrelatedtochloridecom-erythrocyteinducedbysodiumchlorite,-
,;2:1487–99.
CIDassociatedwithchlorinedioxideconsumption,,
hemorrhagiccomplicationswereobserved,andthesodiumchloriteonerythrocytesofa/JandC57L/Jmice.
normalizationoflevelsofplatelets,fibrinogen,;4:513–24.
(COVID-19)Update:FDAWarnsSellerMarket-
ingDangerousChlorineDioxideProductsthatClaimtoTreat
TheexactcauseofAKIsecondarytochlorinecom-
orPreventCOVID-19[Internet].USFoodandDrugAdmin-
poundspoisoningisunknown,butsomemechanismsareistration:April8,2020.[cited2021Feb1]..
“”
remarkable:theoxidativestresscausesexcessiveproduc-gov/news-events/press-announcements/coronavirus-covid-
tionofreactiveoxygenspecies(ROS),whichfinallyleadto19-update-fda-warns-seller-marketing-dangerous-chlorine-
,directdioxide-products-claim
proximaltubulartoxicity,
decloroosolucionmineral
milagrosa(SMM).ComisionFederalparalaProteccioncontra
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