INTRODUCTION: Hydrazine sulfate (HS) is a synthetically manufactured ammonia derivative marketed in the US as a dietary supplement, though many patients still use it for its previously proposed anticancer properties. HS inhibits phophoenol pyruvate carboxykinase thereby blocking gluconeogenesis. In investigations since the 1980s, it has been proven ineffective with respect to its ability to improve cachexia and limit rate of tumor growth as previously postulated. Also, multiple animal trials have shown an increase in the incidence of new lung, liver, and breast tumors with use of HS. It has been listed by the IARC Working Group as a possible carcinogen to humans. Below we discuss a case of acute hepatic and renal failure from HS use after daily ingestion for 24 days. CASE DESCRIPTION/METHODS: Patient is a 74-year-old-female with history of metastatic large cell neuroendocrine rectal tumor status post chemoradiation and resection of colon with ileostomy placement and vaginectomy in 2013. In February 2019, CT chest imaging showed multiple bilateral pulmonary nodules, the largest measuring 2.3 cm, with extensive lymphadenopathy and bilateral pleural effusions. In April 2019, patient presented to the hospital with acute encephalopathy with associated transaminitis, hyperbilirubinemia, coagulopathy, and acute renal failure. Subsequent testing included negative hemolysis workup, hepatic viral and autoimmune panel, and MRCP abdomen. Patient had not followed up with oncology aboutpulmonary nodules, and instead took HS 60mg TID for 4 weeks prior to presentation. The patient’s encephalopathy improved after several days of supportive care. She was followed in clinic by gastroenterology with eventual resolution of hepatorenal toxicity after multiple weeks with cessation of HS. DISCUSSION: HS has been proven to be ineffective as any form of cancer treatment, though patients continue take it due to false hopes of cure and its ability to induce a state of euphoria with neurotropic effects. Unfortunately, many patients develop fulminant hepatorenal toxicity, severe gastrointestinal hemorrhage, hepatic necrosis, and autolysis of kidneys instead. The diagnosis of HS toxicity is often overlooked, and if diagnosed in a timely manner, extensive and costly workups could be avoided. Cancer patients with poor prognosis or limited chemotherapeutic options remain at risk for falling prey to seemingly benign naturalistic remedies. This population must be better educated on the dangers of hydrazine sulfate.