Sabrine Sleem, DO1, Jose Russe-Russe, MD2, Prashant Jadav, DO2, Brian Sowka, DO2, Daniel Casas, DO2, Tenzin Tseky, DO2, Brendan Gregg, DO2, Varun Mehta, MD2, Thaddeus Sullivan, DO2, Gary Valvano, DO2, Bruno Mazza, MD2, David Gossat, MD2 1Arnot Ogden Medical Center, Horseheads, NY; 2Arnot Ogden Medical Center, Elmira, NY Introduction: Acute liver injury (ALI) is a rapid onset of hepatic dysfunction, characterized by severe acute hepatocellular necrosis, and manifested by markedly elevated aminotransferases without mental status changes. While acetaminophen is a well-known hepatotoxin, increasing reports implicate over-the-counter (OTC) supplements as up-and-coming etiologies. Pre-workout supplements, including those containing deer antler extract (DAE), may be unacknowledged contributors to supplement-induced liver injury (SILI).
Case Description/
Methods: A 33-year-old previously healthy male who developed acute hepatocellular injury after presenting with intermittent fevers, myalgia, fatigue, and vomiting for the prior 10 days. He reported consuming high doses of acetaminophen (6–8 extra strength tablets daily), Nyquil, and Dayquil, in addition to DAE pre-workout supplement five days prior to presentation. Chemistry showed AST 871 U/L, ALT 1,691 U/L, ALP 263 U/L, and total bilirubin 1.6 mg/dL. Acute and chronic liver disease workup including, acetaminophen level, viral hepatitis panel, autoimmune serologies, tick-borne illnesses screen, and mononucleosis panel were all negative. Imaging was unremarkable. Given the negative workup and recent supplement use, a diagnosis of SILI was made. Interestingly, the DAE supplements contain insulin-like growth factors—known to have hepatotoxic capability. The patient improved clinically with discontinuation of hepatotoxic agents and upon discharge was advised to abstain from DAE supplements. Discussion: There is a need to consider dietary and workout supplements as potential causes of SILI. Patients unknowingly taking widely available pre-workout supplements, particularly when taking OTC medications for fever, cold, and flu when ill, may inadvertently produce ALI. Obtaining a detailed history of supplement use is essential for early identification and management. Providers should counsel patients on the hepatotoxic risks of supplements and urge for greater regulatory oversight.
Figure: AST trend over 6 days
Figure: ALT trend over 6 days
Disclosures: Sabrine Sleem indicated no relevant financial relationships. Jose Russe-Russe indicated no relevant financial relationships. Prashant Jadav indicated no relevant financial relationships. Brian Sowka indicated no relevant financial relationships. Daniel Casas indicated no relevant financial relationships. Tenzin Tseky indicated no relevant financial relationships. Brendan Gregg indicated no relevant financial relationships. Varun Mehta indicated no relevant financial relationships. Thaddeus Sullivan indicated no relevant financial relationships. Gary Valvano indicated no relevant financial relationships. Bruno Mazza indicated no relevant financial relationships. David Gossat indicated no relevant financial relationships.
Sabrine Sleem, DO1, Jose Russe-Russe, MD2, Prashant Jadav, DO2, Brian Sowka, DO2, Daniel Casas, DO2, Tenzin Tseky, DO2, Brendan Gregg, DO2, Varun Mehta, MD2, Thaddeus Sullivan, DO2, Gary Valvano, DO2, Bruno Mazza, MD2, David Gossat, MD2. P3994 - Deer Antler Extract Pre-Workout Ensues Supplement-Induced Liver Injury, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
