The previously healthy 50-year-old man developed malaise, anorexia, abdominal pain, nausea, vomiting, generalized jaundice, scleral icterus and dark urine after he reportedly drank four to five energy drinks daily for three weeks to help him meet the physical demands of his job as a construction worker, according to the study .
It noted that the patient had no known personal or family history of liver disease and had not changed his diet in any way other than beginning to consume energy drinks.
Healthcare providers ran a battery of tests and closely examined his lifestyle before concluding that the development of acute hepatitis “was directly subsequent to excessive consumption of energy drinks,” the discontinuation of which preceded his return to health.
The practitioners determined vitamin B3, also known as niacin, in the drinks likely was the root of the ailment because it is the only ingredient that when consumed in excess can cause liver damage. The research acknowledges that the patient did not consume as much niacin as associated with toxicity, but it was a similar amount to that was consumed by another patient in the only other known case of liver damage associated with energy drink consumption.
In addition, the researchers note, “toxicity is also likely compounded by accumulative effect. Each bottle of his energy drink contained 40 mg of niacin, or 200% of the recommended daily value.”
While the current case, as with the previous one, is “only suggestive and not conclusive evidence of a causal relationship,” the researchers hope that by publishing their findings they can help raise awareness of the risk of consuming energy drinks.
“With the increasing popularity of energy drinks, clinicians should … be aware of the potential adverse effects associated with their consumption and inquire about energy drink intake in otherwise healthy adults who present with unexplained hepatitis.”
They also recommend that people with pre-existing hepatic disorders should use caution when consuming energy drinks containing niacin.
In addition, they criticize consumers’ general misconception that the “natural ingredients” in energy drinks render them harmless.
“It has been estimated that about 23,000 emergency department visits each year are due to adverse events related to dietary supplements,” which is often how these products are categorized, the study notes.
A history of adverse effects
The case recalls several other high profile incidents involving energy drinks and shots over the years, including a congressional investigation into the safety and marketing practices of energy drink manufacturers .
Leading up to that hearing were several cases in which energy drinks were blamed for injury and death. The most famous such case, perhaps, was the death of a Maryland teenager whose parents sued Monster Energy for liability . In that case, the girl died of cardiac arrest after allegedly drinking two 24 ounce cans of Monster Energy in 24 hours. The company countered that there was no causal connection.
More recently, a man was rushed to intensive care for severe potassium deficiency after drinking four cans of the energy drink Burn within three hours.
As expected, the negative media surrounding these and similar events prompted some consumers to leave the category or to cut back consumption based on health concerns, according to Mintel research . But, the need for energy and demand for convenience continues to attract consumers to the category, which Mintel projected in 2014 would continue to grow steadily through 2018.
BMJ Case Reports
November 1, 2016; doi:10.1136/bcr-2016-216612
'Rare cause of acute hepatitis: a common energy drink'
Authors: Jennifer Nicole Harb, Zachary A Taylor, Vikas Khullar, Maryam Sattari