Acute Hepatitis in a Woman Following Excessive Ingestion of an Energy Drink

A Case Report

Abhirami Vivekanandarajah; Shirley Ni; Alain Waked

Disclosures

J Med Case Reports. 2011;5 

In This Article

Case Presentation

A 22-year-old healthy Caucasian woman presented to the Emergency Department (ED) of our hospital with epigastric pain, nausea, vomiting, and low-grade fever. During the two weeks before her presentation to the Emergency Department, she had been consuming about 10 cans of an energy drink daily. She denied ingestion of alcohol, other medications, or illicit drugs. Her diet was unchanged. Initially, her physical examination was unremarkable except for mild epigastric tenderness. Blood tests revealed an aspartate aminotransferase (AST) level of 171U/l, an alanine aminotransferase (ALT) level of 216U/l, and a total bilirubin level of 1.7 mg/dl. A computed tomographic scan of her abdomen and pelvis with oral and intravenous contrast enhancement revealed no abnormalities, and she was discharged to home from the ED. The following day she returned with worsening pain and new-onset jaundice. Her examination was unchanged, with the exception of icteric sclera. Her AST, ALT, and international normalized ratio values were 7709U/l, 7533U/l, and 1.6, respectively. Her total bilirubin, direct bilirubin, and albumin levels were 3.5 mg/dl, 1.9 mg/dl and 3.8 g/dl, respectively. Her γ-glutamyl transpeptidase level was 29U/l, her acetaminophen level was undetectable, and her ammonia level was 23 μM/l. Her alkaline phosphatase, amylase, and lipase levels were normal. Her toxicology screen was negative. Ultrasound of the abdomen showed non-specific borderline gallbladder wall thickening. She was admitted with a diagnosis of acute hepatitis. Serology tests for Epstein-Barr virus; cytomegalovirus; and hepatitis A, B, C, and E virus were negative. An autoimmune work-up was not performed. She received intravenous hydration and nothing by mouth initially. She continued to improve, and her diet was advanced. Four days later she was discharged to home after her symptoms had resolved. Her AST, ALT, and total bilirubin levels were 238U/l, 1947U/l, and 1.7 mg/dl, respectively, upon discharge. She returned to the medical clinic for follow-up after one month, and the ALT and AST results were 22U/l and 26U/l, respectively, at that time.

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