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Hydroxycitric Acid Present in Garcinia Cambogia Diet Pills Resulting in Starvation Ketoacidosis
Critical Care SESSION TITLE: Critical Care 3 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 04:30 PM - 05:30 PM
Hydroxycitric Acid Present in Garcinia Cambogia Diet Pills Resulting in Starvation Ketoacidosis Tanzib Hossain* David Fridman and Pedro Rivera New York University, New York, NY INTRODUCTION: The fruit of the Garcinia cambogia tree has been used as a weight-loss supplement. The active ingredient hydroxycitric acid. However, it has been associated with serotonin syndrome and acute hepatitis. Here we present a case of Garcinia cambogia diet pill ingestion resulting in starvation ketoacidosis requiring admission to the intensive care unit. CASE PRESENTATION: Our patient is an 18 year old woman with no significant past medical history who presented to the emergency room for 2 weeks of epigastric abdominal pain and 4 days of anorexia, nausea, and emesis. In the emergency department, the patient was hypotensive and tachycardic. Labs revealed a bicarbonate of 7, an anion gap of 23, a venous pH of 7.17, and a lactate of 0.87. Her serum was negative for alcohol, salicylates, and acetaminophen and she had a negative urine toxicology screen. Here complete blood count and hepatic function panels were normal. However, her urinalysis was positive for large glucose and ketones despite a serum glucose of 95. Of note, the patient did not have diabetes and so was not on any oral medications for glycemic control. Given the patient’s hypotension, profound acidemia, and ketonuria, she was resuscitated with intravenous fluids and placed on an insulin drip for presumed euglycemic diabetic ketoacidosis. Then after further questioning, the patient noted that one week prior to the start of her abdominal pain she began taking a diet pill she bought online that was shipped from Thailand that contained Garcinia cambogia. Over the course of the next 48 hours the patient was resuscitated, had return of her baseline mental status, was taken off the insulin drip, had her metabolic derangements normalize, and was able to tolerate a normal diet prior to discharge home. DISCUSSION: Hydroxycitric acid in Garcinia cambogia is known to inhibit ATP-dependent citrate lyase, which catalyzes the cleavage of citrate to oxaloacetate and acetyl-CoA. In so doing, it inhibits fatty acid production and assists in gluconeogenesis eventually leading to appetite suppression.
CRITICAL CARE
CONCLUSIONS: Garcinia cambogia diet pills are increasingly used for weight loss with limited reports of side effects, but one significant toxicity can be starvation ketoacidosis due to the effects of the hydroxycitric acid on appetite suppression. Reference #1: Márquez F, Babio N, Bulló M, Salas-Salvadó J. “Evaluation of the safety and efficacy of hydroxycitric acid or Garcinia cambogia extracts in humans.” Critical Revies in Food Science and Nutrition. 2012;52(7):585-94 DISCLOSURE: The following authors have nothing to disclose: Tanzib Hossain, David Fridman, Pedro Rivera No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.310
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
284A
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152#4S CHEST OCTOBER 2017
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Hydroxycitric Acid Present in Garcinia Cambogia Diet Pills Resulting in Starvation Ketoacidosis Tanzib Hossain* David Fridman and Pedro Rivera New York University, New York, NY INTRODUCTION: The fruit of the Garcinia cambogia tree has been used as a weight-loss supplement. The active ingredient hydroxycitric acid. However, it has been associated with serotonin syndrome and acute hepatitis. Here we present a case of Garcinia cambogia diet pill ingestion resulting in starvation ketoacidosis requiring admission to the intensive care unit. CASE PRESENTATION: Our patient is an 18 year old woman with no significant past medical history who presented to the emergency room for 2 weeks of epigastric abdominal pain and 4 days of anorexia, nausea, and emesis. In the emergency department, the patient was hypotensive and tachycardic. Labs revealed a bicarbonate of 7, an anion gap of 23, a venous pH of 7.17, and a lactate of 0.87. Her serum was negative for alcohol, salicylates, and acetaminophen and she had a negative urine toxicology screen. Here complete blood count and hepatic function panels were normal. However, her urinalysis was positive for large glucose and ketones despite a serum glucose of 95. Of note, the patient did not have diabetes and so was not on any oral medications for glycemic control. Given the patient’s hypotension, profound acidemia, and ketonuria, she was resuscitated with intravenous fluids and placed on an insulin drip for presumed euglycemic diabetic ketoacidosis. Then after further questioning, the patient noted that one week prior to the start of her abdominal pain she began taking a diet pill she bought online that was shipped from Thailand that contained Garcinia cambogia. Over the course of the next 48 hours the patient was resuscitated, had return of her baseline mental status, was taken off the insulin drip, had her metabolic derangements normalize, and was able to tolerate a normal diet prior to discharge home. DISCUSSION: Hydroxycitric acid in Garcinia cambogia is known to inhibit ATP-dependent citrate lyase, which catalyzes the cleavage of citrate to oxaloacetate and acetyl-CoA. In so doing, it inhibits fatty acid production and assists in gluconeogenesis eventually leading to appetite suppression.
CRITICAL CARE
CONCLUSIONS: Garcinia cambogia diet pills are increasingly used for weight loss with limited reports of side effects, but one significant toxicity can be starvation ketoacidosis due to the effects of the hydroxycitric acid on appetite suppression. Reference #1: Márquez F, Babio N, Bulló M, Salas-Salvadó J. “Evaluation of the safety and efficacy of hydroxycitric acid or Garcinia cambogia extracts in humans.” Critical Revies in Food Science and Nutrition. 2012;52(7):585-94 DISCLOSURE: The following authors have nothing to disclose: Tanzib Hossain, David Fridman, Pedro Rivera No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.310
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
284A
[
152#4S CHEST OCTOBER 2017
]