P5: Nutrient Drinks’ And Hepatic Impairment In Children: A Case Report

Dietary health food supplementation is rampant today with nutrient drinks being the latest fad. Nutrient drinks are touted to boost the immune system and are safe. We describe 2 children with autoimmune diseases and previously normal liver function who developed hepatic impairment following consumption of nutrient drinks. Case 1 is a 12- year old Chinese boy, with SLE Class IV Lupus nephritis undergoing intravenous Cyclophosphamide therapy. He presented 1 week after his third dose of iv Cyclophosphamide with 2 days of jaundice. His liver was 4cm palpable and had cholestatic jaundice and hepatic impairment (ALT 1419 iu/L, AST 604 iu/L). He started consuming Juice A (a grape juice concentrate) 4 days prior to jaundice onset. Upon stopping Juice A, his elevated transaminases improved only to deteriorate again necessitating a liver biopsy which showed features of ‘drug induced hepatitis’. Further history revealed consumption of Juice B (a cactus juice concentrate with honey). After stopping all juices, his liver impairment gradually improved and resolved after 2 months. Case 2 is a 3-year old Chinese boy with undifferentiated autoimmune disease receiving iv Cyclophosphamide therapy. He was asymptomatic but incidentally noted to have elevated transaminases (ALT 223 iu/L, AST 135 iu/L). Further history revealed consumption of Juice B. After stopping Juice B, the elevated transaminases normalized within 1 month. Conclusion: A specific history of health supplement ingestion must be sought in any child with hepatitis as most parents do not consider these as ‘drugs’. Nutrient drinks can be potentially harmful, causing hepatic impairment especially in the background of other existing diseases or concomittant drug ingestion.