Acute Kidney Injury and Hepatitis Associated With Energy Drink Consumption

A Case Report

Raed Al Yacoub; Debra Luczkiewicz; Christopher Kerr

Disclosures

J Med Case Reports. 2020;14(23) 

In This Article

Case Presentation

A 62-year-old white woman who had been enrolled in hospice care for 4 months since discontinuing treatment for small cell carcinoma of the left lung presented to the hospice in-patient unit with several days' history of progressive confusion, fatigue, poor sleep, decreased intake, nausea, and vomiting. On initial assessment her condition was thought to most likely stem from progression of her cancer. She was treated symptomatically for nausea and delirium, but continued to decline, developing diaphoresis, decreased level of consciousness, increased weakness, and lethargy. Further history revealed that over several weeks prior to admission her appetite had declined with minimal intake except for five to six cans of a 16 fluid ounce sugar-free ED daily.

On day 3, laboratory tests revealed significant hepatic and renal dysfunction. Baseline kidney and liver tests had been within normal range 2 months previously, except for mildly elevated alkaline phosphatase (ALP) (Table 1). A chest X-ray showed no acute cardiopulmonary disease. She received hydration with normal saline, empiric treatment of infection with ceftriaxone because of elevated white blood cell (WBC) count, and her home medications were adjusted for liver and kidney functions. Repeat laboratory tests on day 6 showed slightly improved liver but worsening renal function (Table 1). A urine culture was negative, and WBC normalized. Ultrasound revealed normal liver echogenicity, normal gallbladder with wall thickness 2 mm, mild extrahepatic and intrahepatic duct dilatation (seen on previous imaging), and normal kidneys.

The family confirmed our patient's wishes to avoid transfer to the hospital or aggressive interventions such as dialysis or further intravenously administered antibiotics and was accepting of the possibility of limited prognosis. Supportive care was provided with hydration, parenteral medications, and symptom management. On days 8–9, she became more alert and began to take food, fluids, and medications reliably by mouth. Repeat laboratory tests on day 10 showed significant improvement consistent with her clinical condition with normal renal function and greatly improved liver enzymes. She returned to her baseline mental and functional status and was discharged home on day 14 with instructions to avoid further consumption of any ED products.

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