RESUMO
In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.
Assuntos
Atletas , Desempenho Atlético , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/induzido quimicamente , Suplementos Nutricionais/efeitos adversos , Fígado/efeitos dos fármacos , Medicamentos sem Prescrição/efeitos adversos , Substâncias para Melhoria do Desempenho/efeitos adversos , Doença Aguda , Adolescente , Biomarcadores/sangue , Biópsia , Carnitina/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Colestase/sangue , Colestase/diagnóstico , Colestase/tratamento farmacológico , Creatina/efeitos adversos , Humanos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/patologia , Testes de Função Hepática , Imageamento por Ressonância Magnética , Masculino , UltrassonografiaRESUMO
We present two cases of acute liver injury resulting from consumption of wild mushrooms. The first case was a male who developed acute hepatitis after ingestion of diverse mushrooms including Amanita species. His clinical course was favorable with complete recovery of liver function. The second case was a male who developed acute liver failure (ALF) after ingestion of Amanita bisporigera. He required MARS therapy as a bridge to liver transplantation but transplantation was not performed because he succumbed to multiorgan failure. There are few trials demonstrating the efficacy of the different treatments for mushroom poisoning. These cases demonstrate that the consumption of wild mushrooms without proper knowledge of toxic species represents a serious and under recognized health problem.