Emergency Department Visits for Adverse Events Related to Dietary Supplements

Abstract

Background: Dietary supplements, such as herbal or complementary nutritional products and micronutrients (vitamins and minerals), are commonly used in the United States, yet national data on adverse effects are limited.

Methods: We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements.

Results: On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement-related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits.

Conclusions: An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.).

Figure 1.. National Estimates of Emergency Department Visits for Dietary Supplement Adverse Events by Patient Sex and Product Category—United States, 2004–2013:

Excludes unsupervised child ingestions. For the following product category/sex combinations national estimates are based on <20 cases or have a coefficient of variation >30% and may be statistically unstable: Sexual Enhancement (Females); Bodybuilding (Females); Calcium (Males). National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, CDC.

Figure 2.. National Estimates of Emergency Department Visits for Dietary Supplement Adverse Events by Patient Age Group and Product Category—United States, 2004–2013:

For the following product category/age group combinations, national estimates are based on <20 cases or have a coefficient of variation >30% and may be statistically unstable: Weight Loss (≥65 years); Energy (50–64 years and ≥65 years); Cardiovascular Health or Potassium (5–19 years and 20–34 years); Calcium (5–19 years, 20–34 years, and 35–49 years); Iron (5–19 years and 50–64 years). National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, CDC.