Rare cause of acute hepatitis: a common energy drink

Abstract

A previously healthy man aged 50 years presented with malaise, anorexia, abdominal pain, nausea, vomiting, generalised jaundice, scleral icterus and dark urine. He was not on any prescription or over-the-counter medications, but reported drinking 4–5 energy drinks daily for 3 weeks prior to presentation. Physical examination revealed jaundice and right upper quadrant abdominal tenderness. Laboratory studies were remarkable for transaminitis and evidence of chronic hepatitis C infection. Ultrasound scan demonstrated an echogenic liver and diffuse gallbladder wall thickening. Liver biopsy showed severe acute hepatitis with bridging necrosis and marked cholestasis. The patient was treated supportively with complete resolution of his symptoms and marked improvement in his laboratory abnormalities. The development of acute hepatitis in this patient was likely secondary to excessive energy drink consumption. Energy drinks as well as other herbal/over-the-counter supplements should be considered by clinicians in the workup of patients with acute hepatitis, particularly once other aetiologies have been excluded.

Metabolic consequences of discretionary fortified beverage consumption containing excessive vitamin B levels in adolescents

“…For example, a single serving is below the B 6 UL of 60mg per day for 9-13y, but more than one serving would exceed this limit. Although B-vitamins play crucial roles in numerous enzymatic reactions, high doses have been associated with toxicity [34, 35]. Whilst toxicity is unlikely due to high tolerance limits [34], several servings of FB might be a concern to young children and adolescents due to their lower body mass.…”

Energy drinks and adolescents – A hepatic health hazard?

“…7 We note two case reports of energy-drink-related acute hepatitis, where the patients in question had consumed large volumes of energy drinks for two and three weeks, respectively. 8,9 In both cases, the authors hypothesised that the mostly likely causative agent of the hepatotoxicity was niacin. These cases highlight that the toxicity profiles and interactions of energy drink ingredients are largely unknown.…”

“…These cases highlight that the toxicity profiles and interactions of energy drink ingredients are largely unknown. 8,9 Energy drinks also contain the stimulant caffeine, and whilst this may afford some protection against liver fibrosis, 3 protection against developing NASH is not established. 10 Adolescents may not be aware of the potential dangers of consuming energy drinks.…”

Acute kidney injury and hepatitis associated with energy drink consumption: a case report

“…Previous case reports revealed acute kidney injury (AKI) induced by excessive ED consumption thought to be due to taurine, [4,5] while others reported acute hepatitis (AH) attributed to niacin [6][7][8]. The doses that caused the injuries varied and are probably due to interactions with other ingredients.…”