Man develops acute hepatitis from consuming too many energy drinks

BMJ: A 50 year-old man was admitted to the emergency department  with  acute  hepatitis, most likely due to his intake of 4 - 5 energy  drinks every day for three weeks, reveal doctor s writing in the  journ a l BMJ Case Repor t s. After the man started consuming energy drinks, he developed  malaise, anorexia and worsening abdominal pain, which  progressed to nausea, and vomiting. He originally thought his  symptoms were down to a flu - like syndrome. However, he  became alarmed when he developed dark urine and generalized  jaundice. He didn't note any changes in his diet or use of alcohol, tobacco,  or illicit drugs, apart from consuming energy drinks. As a  construction worker, he used the energy drinks to help get  through his labor - inten sive workday. Physical examination revealed jaundice and right upper  abdominal tenderness. Lab tests revealed high levels of liver  enzymes, called transaminases, indicating liver damage, and  evidence of chronic hepatitis C infection. Liver biopsy showed severe hepatitis.

Doctors who treated the man explain that his development of his  acute hepatitis was likely due to excessive energy drink  consumption, specifically vitamin B3 (niacin). His intake was around 160 - 200 mg daily, below the threshold  expected to c ause toxicity, but similar to a previously  reported energy drink associated hepatitis (around 300 mg of niacin  daily) . Toxicity is likely worsened by accumulative effect. Each bottle of  his energy drink contained 40 mg of Niacin, or 200% of the  recommend ed daily value . The patient was treated with close observation, frequent  monitoring, and symptom management. He discontinued  consumption of all energy drinks and he was advised to avoid  any similar niacin - containing products in the future. Around 50%  of  cases of liver failure in the US are due to drug  induced liver injury, explain the doctors. The list of associated  drugs and toxins has significantly grown as the market for  dietary and herbal supplements continues to rapidly expand. Estimates sugges t approximately 23,000 emergency department  visits each year are due to adverse events related to dietary  supplements . "As the energy drink market continues to rapidly expand,  consumers should be aware of the potential risks of their various  ingredients. Vitamins and nutrients, such as niacin are present in  quantities that greatly exceed the recommended daily intake,  lending to their high risk for harmful accumulation and toxicity,"  they conclude.