Ingestion of Minoxidil Associated with Elevated Transaminases in the Absence of Ischemic Hepatitis

A previously healthy 18-year-old woman ingested 60 mL of 5% topical minoxidil solution and presented with hypotension, tachycardia, and elevated liver enzymes (aspartate and alanine aminotransferases at 224 and 384 IU/L, respectively). Despite the absence of acetaminophen and ethanol, she developed pulmonary edema and required treatment with isotonic crystalloid, N-acetylcysteine, phenylephrine, and midodrine. She fully recovered and was discharged 108 hours post-ingestion. This case suggests that minoxidil toxicity can cause elevated transaminase levels, indicating potential liver involvement.