Acute Liver Failure with Renal Impairment Related to the Abuse

There is increasing interest for complementary medicinesand, in particular, for herbal remedies. Information documenting adverse reactions to these products is based on case reports and literature reviews.1,2 Potential hepato-toxicity of these agents is suspected when a temporal rela-tionship can be demonstrated between consumption of the product, development of hepatotoxicity, and improvement after discontinuation, after excluding other causes of liver disease. The true incidence of adverse hepatic manifesta-tions caused by herbal remedies remains unknown. It has been estimated that the incidence of hepatotoxicity from Chinese herbal remedies reaches 0.2–1%.3 Self-medication with herbal laxatives is very common. Anthranoid-con-taining laxatives should be used only for limited times. We describe the case of a woman who daily used, for>3 years, an herbal tea made from Sennae fructus angustifoliae. Case Report A 52-year-old woman (52 kg) was admitted to the emergency depart-ment for generalized weakness and lost of appetite. On admission, she was stuporous and confused and her extremities were cold and cyanotic. Vital signs were HR 110 beats/min, arterial BP 80/50 mm Hg, and T 36.3 ˚C. Relevant laboratory data included blood glucose 40 mg/dL, he-moglobin 17.9 g/dL, urea 63 mg/dL, creatinine 3.2 mg/dL, uric acid 6.7 mg/dL, sodium 138 mEq/L, chloride 96 mEq/L, calcium 10.2 mg/dL, phosphorus 6 mg/dL, aspartate aminotransferase (AST) 6640 IU/L, ala-nine aminotransferase (ALT) 9160 IU/L, γ-glutamyl transferase 160 IU/L, bilirubin 6.2 mg/dL, international normalized ratio (INR) 5.27, and factor V 19%. Arterial blood gas analysis revealed pH 7.18, pCO2 23 mm Hg, total CO2 8 mmol/L, base deficit 19 mmol/L, and lactate 14.