A 6y old girl is rushed into ER in unresponsive state

Chubby & cute, her prettiness is mauled by the deepest jaundice

As I watch ER docs intubate the child to protect her airways, my heart races, palms sweat

Bcoz I knw this is a different ball game called

Pediatric Hepatology
...the child was healthy & playful until 6 wks back

She started having cough and low grade fever

Nothing serious,

The local physician said & prescribed her cough syrups and low dose paracetamol as required

Fever settled, but the cough did not,
Cough syrups were changed...
...but after 2 weeks, the child started losing appetite and refused play time, resting on bed most of her time

And then, a week later, she was jaundiced

She was rushed to the nearby clinic where they evaluated her for causes of jaundice

Viral hepatitis was negative...
...Respiratory viruses, atypical viruses that attack the liver such as Herpes and Zoster were all checked and negative

Even though she improved a little, her jaundice deepened and her food intake was very poor

She was fed through a tube placed in the stomach thru her nose...
...Autoimmune hepatitis markers in blood
- ANA, ASMA, antiLKM-1 were all negative

As her jaundice worsened, she started behaving weirdly - she could not identify the parents

Docs there knew what this was
Jaundice, followed by altered behavior (called hepatic encephalopathy)...
...means that the child had gone into

Acute Liver Failure (a condition were a perfectly healthy liver fails completely due to an acute insult, with high death rate due to multiple organ failure)

She was referred emergently
But by the time she reached us, she was in a coma...
...and we had to put her on a ventilator to protect her lungs and start working on her

A race against time

In acute liver failure, finding the cause is of utmost importance, TIME IS LIFE....

So without delay, a liver biopsy was performed, meanwhile other causes looked into...
...every infectious cause we checked for, were negative

Repeat imaging, work up for bacterial and other atypical organisms, Wilson disease and screening for metabolic diseases were all negative...

No clues and we were distraught...
...finally, biopsy results come in

Pathologist says

"Doc, this is autoimmune hepatitis, but its not classical autoimmune hepatitis, as I am seeing many other types of inflammatory cells in the liver - its a mixed bag, so many things going on"

- "go back to the drug history"...
...So we went back to drugs she was on

Salbutamol syrups, levocetrizine, occasional paracetamol (1.5g over a 2 week period) and ambroxol syrups - none of these were liver toxic!

But then her mother tells us, sheepishly that along with these drugs, she was also given...
...a home made juice from a herb that was given by the local Ayurveda practitioner (when her cough was not improving)

- around 40ml/day for 3 weeks for her cough

We tuk a look at it & everything started making sense...

"Herbal does not mean safe - for liver AND kidneys too"
Tinospora cordifolia/heart-leaved moonseed or commonly known as guduchi/giloy is Ayurveda's pet herb that is used to treat diseases ranging from cold to cancers

Word “giloe”, Hindu mythological term refers to a heavenly elixir providing immortality... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924974/
...But recent studies have shown that Giloy has a dark side

- that certain plant alkaloids in it can trigger the human immune system to attack the liver

- leading to HERB-INDUCED AUTOIMMUNE HEPATITIS which has both features of autoimmune hepatitis + herbal liver injury...
...the absence of autoimmune markers in this child along wit liver biopsy showing autoimmune hepatitis features along with other injury features was confirmation that

Giloy juice triggered hepatitis in healthy child,

leading to liver failure

The data is there for all to see...
...removing this fact about Giloy from Wikipedia pages

And is issuing multiple press releases and advertisements, showing Giloy to be safe - when in fact, NO QUALITY, VALIDATED SAFETY STUDIES of Giloy in humans are available...

https://twitter.com/pibfactcheck/status/1412752511891427329

https://en.wikipedia.org/wiki/Tinospora_cordifolia
...Largest series of Giloy liver injury was reported from India by The Liver Research Club India
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep4.1904

and a letter to the Prime Minister of India was written to call attention to this public health concern
https://twitter.com/theliverdr/status/1505806017136771075

Which went unanswered...
...at one point I thought we'd lose the child.

Lost sleep thinking abt next day challenges

Lost sleep thinking how I will discuss her death with parents

Saw my own children & felt depressed

But we went all out with scientific evidence at hand, to treat dreaded liver failure..
...after diagnosing Giloy-triggered severe autoimmune hepatitis in young girl, we put her on aggressive immune suppression therapy

After which she was extubated from the ventilator in 6 days, and...

...She was discharged to home after 3 weeks
& fully recovered after 8 weeks...
...Giloy hepatitis is real.

Those with history of autoimmune disorders/ or at risk for autoimmune liver injury such as those with diabetes, hypothyroidism, rheumatoid arthritis, lupus

- MUST NOT consume products containing Giloy

CHECK YOUR HERBAL SUPPLEMENTS.
This is EXACTLY the problem

Use of untested, potentially toxic traditional medicines DID NOT prevent/reduce Covid-19 in India, it only created more patients burdening resources of an already burdened national healthcare system

This included 'AVOIDABLE' cases of Giloy hepatitis
You can follow @theliverdr.
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