2442 Garcinia Cambogia, Weight Loss at What Price?

Abstract

INTRODUCTION: As obesity levels in the United States continue to rise, more Americans are turning to the use of weight loss supplements. The perception of herbal supplements as an “all-natural” alternative has led to an increase in their use as well as a false sense of security in their safety profile. Garcinia cambogia (GC) is one such weight loss supplement. GC has been a topic of controversy, being scrutinized in multiple case studies as a potential cause of herb induced liver injury (HILI), a subset of drug induced liver injury (DILI). We present a case of DILI secondary to the ingestion of GC in the setting of alcohol and quetiapine use. CASE DESCRIPTION/METHODS: A 46-year-old female with past medical history significant for bipolar disorder and depression presented to the emergency department with complaints of acute right upper quadrant abdominal pain and distention for two days. Initial blood tests showed transaminitis, hyperbilirubinemia, and coagulopathy. The abdomen was mildly tender to deep palpation within the right upper quadrant; no jaundice or scleral icterus was noted. Imaging showed evidence of fatty infiltration of the liver. The patient denied prior history of liver disease, however she admitted to increased daily alcohol consumption over the last several months and long-term high-dose quetiapine use. An exhaustive work-up for alternative etiologies of liver disease was negative. The patient's liver injury was deemed to be drug-induced, secondary to the synergistic effects of GC in the setting of high-dose quetiapine ingestion and alcohol use. Supportive care was continued with improvement in the liver enzymes and bilirubin, and patient was discharged home with a decreased dose of quetiapine and instructions to follow up with psychiatry. One-week follow up labs showed continued down trending of liver enzymes and bilirubin. DISCUSSION: We present this case to emphasize the importance of considering the compounding effects of multiple hepatotoxic substances when mitigating a patient's risks for long-term liver damage. Our case highlights how multiple hepatotoxic insults can create a synergistic effect great enough to push the liver beyond its detoxification limits. Additionally, it demonstrates the importance of healthcare providers acting as diligent investigators of a patient’s home medications, supplements and lifestyle habits. Heightened sense of vigilance is necessary in order to prevent liver injury and its subsequent complications.