Emergency Department Visits for Adverse Events Related to Dietary Supplements

Dietary supplements are widely used in the United States. According to the 2022 National Center for Health Statistics, about 77% of adults report taking at least one supplement in the past 30days. While many products are safe when used as directed, a growing body of evidence shows that supplements can cause serious, sometimes lifethreatening adverse events (AEs) that result in emergency department (ED) visits.

Why Study ED Visits?

ED data provide a realtime snapshot of severe, clinically significant events that lead people to seek urgent care. Unlike voluntary reporting systems, which are subject to underreporting, ED visits are captured systematically by hospital networks and national surveillance programs. Monitoring these visits helps public health authorities identify:

• Highrisk supplement categories (e.g., weightloss, sports, herbal products).
• Populations most affected (age, gender, comorbidities).
• Common clinical presentations (hepatic injury, cardiovascular toxicity, allergic reactions).
• Opportunities for regulatory action and consumer education.

Key Sources of Data

Two primary surveillance systems are used in the United States:

1. National Electronic Injury Surveillance System All Injury Program (NEISSAIP) collects data from a stratified sample of hospitals and records details of ED visits for supplementrelated injuries.
2. Food and Drug Administrations (FDA) Center for Food Safety and Applied Nutrition (CFSAN) Adverse Event Reporting System (FAERS) includes voluntarily submitted reports of supplementrelated AEs, many of which arise from ED encounters.

Recent Findings (20182023)

Year	Estimated ED Visits* (millions)	Top Supplement Categories	Most Common Clinical Manifestations
2018	0.23	Weightloss, herbal, sports nutrition	Cardiovascular (tachyarrhythmia, hypertension), hepatic injury
2020	0.28	Weightloss, vitamins/minerals, botanical extracts	Gastrointestinal bleeding, allergic reactions, seizures
2022	0.31	Weightloss, sports, herbal blends	Cardiac toxicity, acute liver failure, rhabdomyolysis
2023	0.33	Weightloss, bodybuilding, botanical teas	Severe hypertension, acute kidney injury, anaphylaxis

*Estimates are derived from NEISSAIP weighted data; actual numbers may vary.

Population Groups at Highest Risk

• Young adults (1834years) frequently use sports and bodybuilding supplements; prone to cardiovascular and musclerelated toxicities.
• Middleaged women (3554years) often consume weightloss and laxative products; associated with electrolyte disturbances and severe dehydration.
• Older adults (65years) take multiple vitamins/minerals and herbal teas; increased risk of drugsupplement interactions and renal injury.
• Individuals with chronic diseases especially those on anticoagulants, antihypertensives, or psychiatric medications, experience amplified adverse effects.

Common Adverse Event Types

Cardiovascular Toxicity

Stimulantbased weightloss products (e.g., ephedraderived compounds, synephrine) can cause tachycardia, arrhythmias, myocardial infarction, and stroke. Case series from 2021 reported a 3fold increase in ED visits for hypertensive crisis among users of thermogenic supplements.

Hepatotoxicity

Herbal extracts such as green tea concentrate, kava, and pennyroyal have been implicated in acute liver injury. The median latency from initiation to presentation is 46weeks, often with jaundice, elevated transaminases, and coagulopathy.

Renal Injury

Highdose creatine, protein powders contaminated with heavy metals, and certain botanical diuretics can precipitate acute kidney injury (AKI). Studies show that 12% of supplementrelated ED visits in 2022 involved AKI.

Musculoskeletal Complications

Excessive use of anabolic androgenic steroids and preworkout blends containing DMAA or alanine can trigger rhabdomyolysis, leading to myoglobinuria and potential renal failure.

Allergic and Anaphylactic Reactions

Proteinbased supplements (e.g., whey, soy) and herbal teas may contain hidden allergens. Anaphylaxis accounts for about 5% of supplementrelated ED presentations, requiring immediate epinephrine administration.

Regulatory and Safety Challenges

Dietary supplements are regulated under the Dietary Supplement Health and Education Act of 1994 (DSHEA), which classifies them as foods rather than drugs. This framework creates several gaps:

• Manufacturers are not required to prove safety before marketing.
• Label claims can be misleading; natural does not guarantee safety.
• Adverse event reporting is largely voluntary, leading to undercapture of data.
• Thirdparty testing varies; contaminants such as heavy metals, pesticides, or prescription drugs are sometimes present.

Prevention Strategies for Consumers

1. Read labels critically. Look for a full ingredient list, dosage instructions, and any contains statements for allergens.
2. Verify thirdparty certifications. Organizations such as USP, NSF International, and InformedChoice test products for purity and potency.
3. Consult healthcare professionals. Before starting a new supplement, discuss it with a pharmacist or physician, especially if you take prescription meds.
4. Stay informed about recalls. The FDAs Recall Database lists supplement alerts.
5. Report serious reactions. Use the FDA MedWatch portal to submit AE reports.

Public Health Recommendations

To reduce the burden of supplementrelated ED visits, public health agencies should consider:

• Enhancing mandatory adverseevent reporting for highrisk supplement categories.
• Expanding surveillance to include urgentcare centers and telemedicine visits.
• Funding independent laboratory testing of popular supplements.
• Developing targeted education campaigns for atrisk groups (e.g., athletes, weightloss seekers).
• Collaborating with manufacturers to improve label transparency and limit the use of stimulatory ingredients.

Conclusion

While most dietary supplements are well tolerated, the rise in ED visits for severe adverse events underscores a pressing safety issue. Weightloss and sports nutrition products dominate the landscape, but hepatotoxic, cardiovascular, renal, and allergic reactions are reported across all categories. A combination of stronger regulatory oversight, improved postmarket surveillance, and consumer education is essential to protect public health and reduce unnecessary emergency care utilization.

For clinicians, maintaining a high index of suspicion for supplementrelated toxicity and documenting exposure details can improve patient outcomes and contribute valuable data to national monitoring systems.