Increased Alkaline Phosphatase Associated with Brown Algae and Mushroom Extract-Containing Supplement Use.

Background: Marked alkaline phosphatase (ALP) elevation as a consequence of drug exposure is uncommon. We report a chronic hepatitis B virus (HBV) positive 47-year-old male patient taking a brown algae and mushroom extract-containing supplement (Umi No Shizuku) with ALP levels almost 7 times the upper limit during routine bloodwork. ALP was 991 U/L (normal 50-112 U/L). All other liver studies were within normal range: alanine aminotransferase (ALT) 32 U/L (normal 10-63 U/L), aspartate aminotransferase (AST) 25 U/L (normal 12-41 U/L), gamma-glutamyl transferase (GGT) 22 U/L (normal 11-105 U/L), and total bilirubin 13 µmol/L (normal ≤ 13 µmol/L).

Methods: Serial bloodwork was conducted to assess liver studies and bone disease markers. Imaging was utilized to exclude liver and bone disease.

Results: Bloodwork and imaging all returned values within the normal range. Interrupting the supplement led to rapid normalization of ALP blood levels in the patient.

Conclusions: The supplement was the only variable changed in this case, leading us to suspect that it was responsible for the elevated ALP levels.