Estrium Whey induced hepatitis in a patient with metastatic breast cancer: Case report

Table 1 Ingredients of Estrium Whey formula

Total fat	2 g
Saturated fat	0.5 g
Cholesterol	< 5 mg
Total carbohydrate	25 g
Dietary fiber	2 g
Sugars	19 g
Protein	15 g
Vitamin A (as retinyl palmitate)	1250 IU
Vitamin A (as beta-carotene)	2500 IU
Vitamin C (as ascorbic acid)	60 mg
Vitamin D (as cholecalciferol)	40 IU
Vitamin E (as d-alpha tocopheryl succinate)	300 IU
Thiamin (as thiamin HCl)	0.75 mg
Riboflavin	0.85 mg
Niacin (as niacinamide)	10 mg
Vitamin B6 (as pyridoxine HCl)	50 mg
Folate (as folic acid)	400 mcg
Vitamin B12 (as cyanocobalamin)	30 mcg
Biotin	150 mcg
Pantothenic acid (as D-calcium pantothenate)	5 mg
Calcium (as calcium citrate)	350 mg
Iron (as ferrous fumarate)	9 mg
Phosphorus (as dipotassium phpsphate)	260 mg
Iodine (as potassium iodide)	75 mcg
Magnesium (as citrate)	240 mg

Table 2 Liver function tests in the index patient

	On	Days after admission					References
	admission	2	3	4	5	7	values
AST	1203	1600	1588	1693	2051	3050	< 43 U/L
ALT	625	635	613	616	652	173	< 45 U/L
BILI	5.7	7.5	9.1	9.6	10.4	14.1	< 1 mg/dL
AP	281	274	260	276	245	258	108 U/L

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BILI: Total bilirubin; AP: Alkaline phosphatase.