Severe Hepatotoxicity Due to Hydroxycut: A Case Report

Excerpt

A 28-year-old male was transferred to our institution with 3 weeks of fatigue, dyspnea on exertion, jaundice, and dark urine. In an effort to lose weight, he had been taking Hydroxycut, two tablets, two to three times per day (which is within the manufacturer’s suggested dosing), from 3 months prior to admission up until the development of symptoms. Additionally, for soreness associated with his aerobic exercise program, he took an over-the-counter pain-reliever containing acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg, four tablets per day for the 10 days leading up to the development of his symptoms. He was not a heavy drinker of ethanol, drinking 2–3 beers per week. Physical examination was unremarkable and without stigmata of chronic liver disease. Laboratory analysis revealed a serum aspartate aminotransferase of 1049 U/l (normal range 7–36 U/l), alanine aminotransferase of 2272 (normal 4–45 U/l), alkaline phosphatase of 152 U/l (normal 31–103 U/l), total bilirubin of 18.1 mg/dl (normal 0.2–1.1 mg/dl), conjugated bilirubin of 9.0 (normal 0.0–0.2 mg/dl), albumin level of 4 g/dl (normal 3.7–5.1 g/dl), prothrombin time of 12.8 s (normal 9.2–10.6 s), normal complete blood count, normal electrolyte panel, and normal estimated glomerular filtration rate. Aminotransferase levels and prothrombin time began to decline immediately after admission and bilirubin peaked on hospital day 2 at 22.4 mg/dl. Acetaminophen level was undetectable. Tests for viral hepatitis were negative. Ferritin was markedly elevated at 9519 ng/ml (normal 10–210 ng/ml). HFE genotyping was negative for H63D or C282Y mutations. Antinuclear antibody titer was 1:40 (normal, <1:40), smooth muscle antibody titer was 1:20 (normal, <1:20), liver kidney microsomal antibody was negative, and soluble liver antigen antibody was negative. Serum copper level was 96 mcg/dl (normal 70–140 mcg/dl) and ceruloplasmin was 31 mg/dl (normal 18–54 mg/dl). Twenty-four hour urine copper level was 290 mcg/dl (normal 3–50 mcg/dl). Slit-lamp examination for Kaiser-Fleischer rings was equivocal. Abdominal ultrasound with Doppler and computed tomography (CT) scan with intravenous contrast were both normal. The patient’s liver function tests continued to improve and he was discharged on hospital day 9. …