S5655 TikTok: A Race Against Time in Acute on Chronic Liver Failure

Introduction: Approximately 239 million Americans are active on social media, and as many as 33% of all U.S. adults report using TikTok. Acute on chronic liver failure (ACLF) is characterized by intense systemic inflammation caused by an acute insult to an underlying liver disease, leading to endothelial dysfunction and eventual multi-system organ failure. This results in a syndrome with a significantly high short-term mortality. Herein, we present a case of ACLF likely from an underlying Metabolic dysfunction-associated steatohepatitis (MASH) and Drug-induced liver injury (DILI). Case Description/Methods: A 45-year-old morbidly obese woman, without any previous medical history, presented with 4 months of facial and bilateral lower extremity edema, 4 weeks of generalized weakness and fatigue, 4 weeks of scleral icterus and jaundice, 2 weeks of changes in mentation, and 1 week of shortness of breath. She was hypotensive with a MAP of 49, tachycardic, tachypneic, hypoxic, needing BiPAP, only oriented to self, with a BMI of >50 worsened by diffuse anasarca. Labs showed WBC 16,000, aspartate aminotransferase 34, alanine aminotransferase 63, Crea 1.49 mg/dL, Total bilirubin 21.3 mg/dL, international normalized ratio >10.0, and Albumin 2.8 g/dL. MELD 3.0 was 35. Autoimmune markers, Acetaminophen, Aspirin, PEth, and Hepatitis viral panel were all negative. Abdominal imaging revealed ascites, splenomegaly, and bilateral pleural effusion. She was intubated due to hypoxic respiratory failure, started on CRRT and vasopressor therapy. CLIF-C ACLF Score was 74, signifying >97% mortality at 1 month from ACLF. Upon further inquiry from family, she was undergoing a “liver detox and weight loss regimen” from TikTok before all of these symptoms started. These herbal remedies were purchased online and included a variety of supplements such as an unspecified Chinese/Korean medication, milk thistle, dandelion, Green tea extract, Green coffee bean extract, Vanadium, Nutra tea, activated charcoal, Yacon Root, Echinacea, and a few other powders. These were not initiated simultaneously. A liver biopsy was not performed due to the clinical instability of the patient. Unfortunately, given her accelerated deterioration and multi-system organ failure, her family elected to transition her to a DNR status and eventual comfort care. Discussion: This case emphasizes the importance of vigilance on social media and highlights the serious implications and consequences of blindly following medical advice from unqualified individuals. A young and promising life was tragically lost in an echo chamber of misinformation.