Abstract: FR-PO1009
Use of Molecular Adsorbent Recirculating System (MARS) in Acute Metabolic Encephalopathy from Herbal Supplement Intoxication
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Khaled, Dina, Methodist Health System, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Health System, Dallas, Texas, United States
- Rodriguez Rivera, Carolina Isabel, Methodist Health System, Dallas, Texas, United States
Group or Team Name
- Dallas Nephrology Associates
Introduction
Herbal and dietary supplements(HDS) are easily obtainable for purchase and not adequately monitored for safety/efficacy. Often, they are marketed to the consumer as being “natural” and may include multiple herbal compounds.
In the US, drug induced liver injury(DILI) is 10-20% attributable to HDS, with prior studies showing needing liver transplantation (56% vs 32%).
MARS is an albumin based dialysis modality used for protein-bound and lipophilic toxins. This case presentation explores the use of MARS in severe metabolic encephalopathy.
Case Description
A 30 y/o Black woman with a PMH of systemic lupus erythematosus(SLE) presented to the ER with abdominal pain, weakness, nausea, and vomiting. She was diagnosed with SLE 18 months ago with mainly arthralgia and was briefly placed on AZA with HCQ then to Belimumab. The patient pursued ayurvedic /holistic therapies, including several detoxifying herbal supplements, instead of the medical SLE treatments.
On presentation, she had severe transaminitis(AST 2249, ALT 410), hyperbilirubinemia(4.5), and elevated lipase(2534). CT abdomen imaging showed hepatomegaly and ascites. She was diagnosed with acute hepatitis, acute pancreatitis, and distributive shock, requiring ICU care for vasopressors, IVF, and antibiotics.
She underwent a liver biopsy which showed diffuse lobular disarray with minimal inflammation and no fibrosis. And subsequently, a kidney biopsy showing (ISN/RPS) class II lupus nephritis with podocytopathy and ATN, requiring IV steroids. During her 4th day of admission, the patient developed acute metabolic encephalopathy and acute respiratory failure and subsequently intubated for airway protection for 3 days. She had normal NH3 levels and CT Brain and her EEG with metabolic encephalopathy.
She received a 3 day course of 12 hours of MARS with alternating 12 hours of CRRT, and there was a remarkable improvement of her encephalopathy leading to extubation.
Discussion
MARS has been studied as a bridge to liver transplantation in the acute setting of intoxication leading to ALF and has demonstrated marked reduction of albumin bound and water soluble toxins.
Studies have shown that MARS can be used as a temporary bridge to transplant/liver recovery by improving encephalopathy, hemodynamics, and toxin clearance such as this case presentation.