A remarkable case of rhabdomyolysis associated with ingestion of energy drink ‘neon volt’

Abstract

Rhabdomyolysis is defined as a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. We present a case of a 35-year-old male who exercised for 2 h after ingesting energy drink and subsequently presented with rhabdomyolysis. After excluding common and uncommon causes of rhabdomyolysis, we reached the conclusion that the likely cause was the ingestion of energy drink ‘NEON VOLT’ in a setting of mild dehydration. Increasing physical activity and intense exercise is becoming a trend in many countries, due to its many health-related benefits such as prevention of obesity. This renewed focus toward optimal fitness has spawned many supplements that aid in improvement of the performance, muscle growth, and recovery. Energy drinks predominantly contain caffeine that is often combined with other supplements to form what manufacturers have termed an ‘energy blend’. Studies have shown that excessive caffeine intake from energy drinks can cause arrhythmias, hypertension, dehydration, sleeplessness, nervousness, and in rare instances, rhabdomyolysis. As per Drug Abuse Warning Network report, there is a sharp increase in the number of emergency department visits involving energy drinks from 1,128 visits in 2005 to 16,053 and 13,114 visits in 2008 and 2009, respectively. Due to emergence of energy drink abuse as a national health problem, Food and Drug Administration has launched a dietary supplement adverse event reporting system for surveillance of any adverse events linked to these agents.

Hypophosphatemia, hypokalaemia and rhabdomyolysis associated with a panic attack

“…Another possible contributor to this presentation was the energy drink consumed by the patient; these drinks usually contain stimulants and have been associated with rhabdomyolysis in conjunction with vigorous exercise. 21 While this mechanism could increase susceptibility to rhabdomyolysis, our patient did not perform abnormally heavy exercise, nor would this explain the observed electrolyte abnormalities. Finally, while not present in this patient, prior reports of panic-related hypophosphatemia have been associated with lactate elevation, 3 and with intermittent weakness, pain, paresthesias and shaking, which were initially misattributed to chronic fatigue, anxiety and Lyme disease.…”

Severe Rhabdomyolysis Due to Strenuous Exercise With a Potential Role of a High-Caffeine Energy Drink

“…Direct causation has not been proven [ 8 ]. Energy drinks have also been associated with rhabdomyolysis [ 9 , 10 ]. The lethal dose of caffeine is 10 g or higher [ 6 ].…”

Energy Drinks; Impact of Use in Patients with Diabetes, Obesity, and/or other Cardiometabolic Spectrum Conditions.

“…Similarly, the potential toxic and pathogenic consequences of carbohydrate excess can be classified into acute effects associated with systemic glucotoxicity (often with associated lipotoxicity) as well as the more chronic consequences of long term carbohydrate excess (that can be conceived as carbotoxicity) 65,[86][87][88]145,146,[184][185][186] . It is reasonable to anticipate that the potential clinical sequelae and toxidromes of long term EDs use in susceptible patients would be amalgam of the clinical presentations of both caffeine and carbohydrate excess as they are the dominant ingredients of these products 90,102,103,126,[187][188][189][190][191][192][193][194][195] .…”