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

Discussion

As patients enrolled in hospice care begin to decline they often seek ways to improve or maintain hydration. EDs differ from "sport drinks" which provide hydration and replete electrolytes.[3] EDs contain high levels of carbohydrates, which affect fluid absorption and cause gastrointestinal distress, and they contain caffeine, which causes diuresis leading to increased urinary output and natriuresis instead of hydration.[3] Unfortunately, there are limited studies about the long-term effects of ED ingredients in humans.[3] Table 2 lists the ingredients in the ED consumed by our patient, who was drinking five to six cans (10–12 servings) per day.

Our patient appeared to develop AKI and AH simultaneously. She denied use of herbal supplements or alcohol; she said she had previously tested negative for viral hepatitis, had no new medications or recent imaging with contrast, and was not on nephrotoxic medications. Her strongest risk factor was her daily consumption of large amounts of EDs. Based on a review of the literature (Table 3), the main contributor to AKI was most probably taurine, and, for AH, niacin, although other ingredients or combinations of ingredients may also have played a role.

Taurine is a sulfur-containing amino acid typically used as a nutritional supplement by athletes to increase performance. There are some data from Suliman et al. suggesting increased risk from taurine intake in patients with renal failure who develop neurological symptoms.[9] Suliman et al. also recommend avoiding EDs in these patients.[9] Our patient consumed 10–12 g/day.

Niacin (vitamin B3) can cause hepatotoxicity at doses between 1 and 5 g/day.[10] The laboratory pattern of liver injury due to drugs or toxins could be hepatocellular, cholestatic, or mixed.[11] AH has been described in several cases at lower levels of niacin consumption as a component of EDs at levels similar to our patient who consumed between 200 and 240 mg/day.

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