title: Successful use of N-acetylcysteine to treat severe hepatic injury caused by a dietary fitness supplement.
abstract: In the absence of adequate premarketing efficacy and safety evaluations, adverse events from over-the-counter supplements are emerging as a public health concern. Specifically, bodybuilding products are being identified as a frequent cause of drug-induced liver injury. We present a case of a 20-year-old Hispanic male who presented with acute nausea and vomiting accompanied by severe right upper quadrant abdominal pain, shivering, and shortness of breath. Laboratory data pointed to mixed cholestatic and hepatocellular damage, and after exclusion of known alternate etiologies, the patient was diagnosed with acute drug-induced liver injury secondary to the use of "Friction," a bodybuilding supplement. Treatment with N-acetylcysteine (NAC) 20% oral solution was initiated empirically at a dose of 4000 mg [DOSAGE ERROR CORRECTED] (70 mg/kg) every 4 hours and was continued once the diagnosis was made. Within 48 hours of admission to our hospital, the patient began to show clinical resolution of right abdominal pain and tolerance to oral diet associated with a significant decline toward normal in his liver function tests and coagulopathy. The WHO-UMC causality assessment system suggested a "certain causality" between exposure to the supplement and the acute liver injury. In the event of suspected drug-induced liver injury, treatment with NAC should be considered given its favorable risk-benefit profile.
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, Texas.
authors.forename: Cynthia
authors.initials: C
authors.lastname: El Rahi
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, Texas.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Thompson-Moore
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Mejia
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Patricio
authors.initials: P
authors.lastname: De Hoyos
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy*; D019587:Dietary Supplements / Q000506:poisoning*; D006801:Humans; D008297:Male; D010809:Physical Fitness; D014665:Vasodilator Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000975:Antioxidants; D014665:Vasodilator Agents; D000111:Acetylcysteine
keywords: hepatotoxicity; liver; supplement