Nav: Home

BMJ Case Reports: Hepatitis & energy drinks; bee stings; opium & lead poisoning

November 01, 2016

Man develops acute hepatitis from consuming too many energy drinks

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 doctors writing in the journal BMJ Case Reports.

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-intensive 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 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 cause 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 recommended 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 suggest 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.

Case Report: A rare cause of acute hepatitis: a common energy drink

Doctors warn of prolonged heart effects of multiple bee stings

Doctors writing in the journal BMJ Case Reports describe the case of a healthy 55-year-old man in India who developed serious heart problems several weeks after being attacked by a swarm of bees.

While walking in a forest, he suffered more than 50 stings, and he was admitted to hospital with facial puffiness, breathlessness and sudden tiredness.

He had no history of heart problems and heart tests were normal. After initial treatment, his condition improved and he was discharged with anti-inflammatory medication.

But around three weeks later, he was back in hospital after developing a dangerously slow heart rate, repeated fainting, and suffering a cardiac arrest. He almost died.

The doctors managed to save his life by inserting a temporary pacemaker, which was later replaced with a permanent pacemaker. His condition improved and he was eventually discharged home.

The doctors suspect the man had developed Kounis syndrome (a group of acute coronary events) triggered by a delayed allergic reaction to the massive amount of bee venom in his system.

Another possible reason, they say, could have been that the bees had consumed the nectar of a rhododendron flower, which contains 'grayanotoxin' (a natural sodium channel blocker that can slow the heart).

The cardiac effects of bee venom have been previously reported. But this case is of particular importance, explain the authors, "because earlier accounts of massive bee stings have not reported significant bradycardia. Hence, we were unaware of this complication, and hesitated to implant a temporary pacemaker."

This report highlights the need to consider heart complications in patients with multiple bee stings, and the need for urgent action in order to prevent death, they conclude.

Case report: Possible complication of bee stings and a review of the cardiac effects of bee stings

Opium smoker develops lead poisoning

A 46-year-old man of Iranian origin developed lead poisoning from smoking contaminated opium, doctors write in the journal BMJ Case Reports.

This a phenomenon that is well documented in Iranian medical literature, and there have been similar cases of lead poisoning caused by contaminated marijuana and heroin.

It's believed that lead is added to increase opium's weight for sale or is a contaminant incorporated during processing. Lead levels can be considerable, say the doctors.

The patient was admitted to the emergency department with a 4-day history of abdominal pain and constipation, and several weeks of irritability and malaise, which had strained his personal relationships.

He had also experienced frequent, widespread 'pins and needle sensations' in his arms and legs. He had smoked 10g of opium per week for a year and a half.

The patient's lead in his blood was 11 times the normal level. He was noted to possibly have Burton's line - blue discolouration of the gums - a clinical sign of lead poisoning.

The patient underwent a treatment to remove the lead from his bloodstream. Since being discharged, the patient returned home, is engaged with drug services and has not smoked opium.

The patient commented: "I am back at work and I feel like I have the power to fight in my life again. I hope my story could alert doctors around the world to other patients, especially other Iranians, where opium smoking is prevalent, who might be suffering like I was."

Public Health England was notified and assessed the patient, in collaboration with the Centre for Radiation, Chemical and Environmental Hazards, to determine the source of lead exposure and any risk to others. It concluded that the likely source of lead exposure was smoking opium.

Following this incident, PHE's guide for lead toxicity investigation will be changed to prompt investigating opium or other drugs as a potential exposure source.

Case Report: Chronic lead poisoning in an Iranian opium smoker resident in London
About the journal:

BMJ Case Reports is an award winning journal that delivers a focused, peer-reviewed, valuable collection of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. This is the largest single collection of case reports online with more than 11,000 articles from over 70 countries. For more information, visit:


Related Hepatitis Articles:

Busting Up the Infection Cycle of Hepatitis B
Researchers at the University of Delaware have gained new understanding of the virus that causes hepatitis B and the ''spiky ball'' that encloses its genetic blueprint.
Liver cancer: Awareness of hepatitis D must be raised
Scientists from the University of Geneva (UNIGE) and the Geneva University Hospitals (HUG) have studied the most serious consequence of chronic hepatitis: hepatocellular carcinoma.
Hepatitis B: New therapeutic approach may help to cure chronic hepatitis B infection
Researchers at Helmholtz Zentrum München, Technical University of Munich (TUM) and the German Center for Infection Research (DZIF) have developed a novel therapeutic approach to cure chronic hepatitis B.
Anti-hepatitis medicine surprises
A new effective treatment of hepatitis C not only combats the virus, but is also effective against potentially fatal complications such as reduced liver functioning and cirrhosis.
Nanotechnology delivers hepatitis B vaccine
X-ray imaging shows that nanostructured silica acts as a protective vehicle to deliver intact antigen to the intestine so that it can trigger an immune response.
Checkmate for hepatitis B viruses in the liver
Researchers at Helmholtz Zentrum München and the Technical University of Munich, working in collaboration with researchers at the University Medical Center Hamburg-Eppendorf and the University Hospital Heidelberg, have for the first time succeeded in conquering a chronic infection with the hepatitis B virus in a mouse model.
How common is Hepatitis C infection in each US state?
Hepatitis C virus infection is a major cause of illness and death in the United States and injection drug use is likely fueling many new cases.
New strains of hepatitis C found in Africa
The largest population study of hepatitis C in Africa has found three new strains of the virus circulating in the general population in sub-Saharan Africa.
High stability of the hepatitis B virus
At room temperature, hepatitis B viruses (HBV) remain contagious for several weeks and they are even able to withstand temperatures of four degrees centigrade over the span of nine months.
Findings could lead to treatment of hepatitis B
Researchers have gained new insights into the virus that causes hepatitis B -- a life-threatening and incurable infection that afflicts more than 250 million people worldwide.
More Hepatitis News and Hepatitis Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at     You can read The Transition Integrity Project's report here.