Dangerous dietary supplements: Garcinia cambogia-associated hepatic failure requiring transplantation

Table 1 Work-up for causes of acute liver failure in reported patient

Laboratory test	Result	Reference range
Hepatic function panel
Aspartate aminotransferase	624 U/L (H)	7-36 U/L
Alanine aminotransferase	520 U/L (H)	4-45 U/L
Alkaline phosphatase	156 U/L (H)	31-103 U/L
Bilirubin, total	34.7 mg/dL (H)	0.2-1.1 mg/dL
Bilirubin, conjugated	14.8 mg/dL (H)	0.0-0.2 mg/dL
Albumin	3.6 g/dL (L)	3.7-5.1 g/dL
Total Protein	5.8 g/dL (L)	6.2-8.6 g/dL
Coagulation factors
Prothombin time	37.9 s (H)	9.1-11.9 s
INR	3.5 (H)	< 1.2
Factor VII activity	< 6% (L)	> 50% activity
Factor V activity	18% (L)	> 50% activity
Tumor markers
CEA	2.3 ng/mL	< 3.1 ng/mL
CA 19-9	235 U/mL (H)	0-35 U/mL
AFP	51.1 ng/mL (H)	1.6-4.5 ng/mL
AFP-L3	19.0% (H)	0.5%-9.9%
PIVKA	4.4 ng/mL	< 6.3 ng/mL
Viral serologies
Hepatitis A, IgM	Nonreactive	Nonreactive
Hepatitis A, IgG	Reactive1	Nonreactive
Hepatitis B surface antigen	Nonreactive	Nonreactive
Hepatitis B surface antibody, quantitative	< 10 IU/L	< 10 IU/L
Hepatitis B core antibody, total	Nonreactive	Nonreactive
Hepatitis C antibody screen	Nonreactive	Nonreactive
Hepatitis C RNA quantitative PCR	Not Detected	Not detected
Hepatitis E antibody, IgG	Not Detected	Not detected
Hepatitis E antibody, IgM	Not Detected	Not detected
CMV antibody immune status	Positive1	Negative
CMV DNA quantitative PCR	Not Detected	Not detected
Liver tissue CMV in situ hybridization	Negative	Negative
EBV-VCA IgM	Negative	Negative
EBV-VCA IgG	Positive1	Negative
EBV DNA quantitative PCR	Not Detected	Not detected
Liver tissue EBV in situ Hybridization	Negative	Negative
Adenovirus DNA Quantitative PCR	Not Detected	Not Detected
Liver tissue adenovirus in situ hybridization	Negative	Negative
Herpes Simplex 1 IgM screen	Negative	Negative
Herpes Simplex 2 IgM screen	Negative	Negative
Liver Tissue HSV 1 and 2 in situ hybridization	Negative	Negative
RPR	Nonreactive	Nonreactive
Autoantibody titer
Antinuclear antibody	Positive1	Negative
Antinuclear antibody titer	1:401	< 1:20
Smooth muscle antibody	< 1:20	< 1:20
Liver kidney microsome antibody IgG	< 20.0 U	< 20.0 U
Soluble liver antigen autoantibody	< 20.1 U	< 20.1 U
Wilson’s disease evaluation
Copper, RBC	0.71 mg/L	0.53-0.91 mg/L
Copper, serum	95 μg/dL	70-140 μg/dL
Ceruloplasmin	22 mg/dL	17-48 mg/dL
Copper, 24-h urine	1055 μg/d (H)	3-50 μg/day
Quantitative liver copper	47 μg/g tissue	10-55 μg/g tissue
Hemochromatosis evaluation
Total iron	243 μg/dL (H)2	23-202 μg/dL
Iron binding capacity	< 308 μg/dL (L)3	240-520 μg/dL
Transferrin	163 mg/dL (L)	198-386 mg/dL
Ferritin	3254 ng/mL (H)	8-350 ng/mL
Alpha-1-antitrypsin	91 mg/dL	83-199 mg/dL
Acetaminophen	< 10 μg/mL	10-20 μg/mL

¹Indicates positive result;

²(H) indicates value above the reference range;

³(L) indicates value below the reference range. AFP: Alpha-fetoprotein; EBV: Epstein Barr virus; CEA: Carcinoembryonic antigen; CMV: Cytomegalovirus; CA 19-9: Carbohydrate antigen 19-9; AFP-L3: Lectin-reactive AFP percentage; HSV: Herpes simplex virus; INR: International normalized ratio; PCR: Polymerase chain reaction; PIVKA: Protein induced by vitamin K absence.