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.

Inflammatory and oxidative stress in rotavirus infection

“…It has been used during several decades as mucolytic agent and also for the treatment of various disorders including paracetamol intoxication [228] . NAC has been also used for treatment of numerous disorders linked to oxidative stress including gastrointestinal [229] , renal [230] , cardiovascular [231] , pulmonary [232] , hepatic [233] , psychiatric and neurological disorders. The mucolytic activity of NAC is due to its ability to break up the disulfide bonds of the high molecular weight glycoproteins present in the mucus.…”

A case of reversible drug‐induced liver failure

“…It is well established that NAC has been proven to decrease the burden of acetaminophen toxicity on the liver by replenishing glutathione which converts toxic metabolites (NAPQI) into benign products . It also has the ability to scavenge oxygen‐derived free radicals and improve endothelium‐dependant perfusion to the liver . Like acetaminophen, cocaine also has toxic metabolites (norcocaine and N‐hydroxynorcocaine) that cause liver damage .…”

“…NAC's role has not been well established as an antidote for nonacetaminophen drug‐induced (NADI) liver failure. A prospective trial showed significantly improved transplant‐free survival at 3 weeks and at 1 year (52% vs. 30%) with the use of NAC for the treatment of NADI liver failure . Another trial showed that NAC was associated with a statistically significant survival benefit (47% vs. 27%) .…”

“…The effects and management of cocaine on the liver and kidney are not as well reported . Current guidelines recommended discontinuation of the offending agent, supportive measures, and if necessary liver transplant . The role N‐acetylcysteine (NAC) is well established in acetaminophen toxicity, but not so much in regard to other substances .…”

“…Current guidelines recommended discontinuation of the offending agent, supportive measures, and if necessary liver transplant . The role N‐acetylcysteine (NAC) is well established in acetaminophen toxicity, but not so much in regard to other substances . Dialysis is a very effective method in removing certain substances from the body.…”