Thousands of ED Visits Tied to Dietary Supplements

Dietary supplements are involved in some 23,000 visits to emergency departments (ED) every year in the United States alone, according to a new report.

Researchers at the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) used nationally representative surveillance data from 63 EDs between 2004 and 2013 to search for adverse events potentially related to dietary supplements. They found a total of 3,667 such cases reported, from which they estimated that 23,005 ED visits per year could be attributed to adverse events related to dietary supplements. According to the researchers, these visits result in an estimated 2,154 hospitalizations annually.

They found that such visits frequently involve young adults 20–34 years of age and unsupervised children. After exclusion of unsupervised ingestion of dietary supplements by children, 65.9% of ED visits for single-supplement-related adverse events involved herbal or complementary nutritional products, with weight loss and increased energy products commonly implicated; a further 31.8% of cases involved micronutrients. Adverse events included palpitations, chest pain, tachycardia, globus, choking, and pill-induced dysphagia. Micronutrients were implicated in 83.1% of these visits. The study was published on October 15, 2015, in the New England Journal of Medicine (NEJM).

“Although that's less than 5% of the figure for pharmaceutical drugs, dietary supplements are regulated and marketed under the presumption of safety. Cardiac symptoms from weight loss and energy supplements accounted for more ED visits than prescription stimulants,” concluded lead author Andrew Geller, MD, and colleagues. “The study probably underestimated the number of ED visits linked to supplements because their use is underreported by patients, and physicians may not always identify the adverse effects associated.”

The US Dietary Supplement and Health Education Act (DSHEA) stipulates that dietary supplements do not need US Food and Drug Administration (FDA) approval to be marketed, with companies only required to report serious adverse events to the agency. Since the DSHEA was passed in 1994, the estimated number of supplement products rose from 4,000 to more than 55,000 in 2012, amounting to some USD 15 billion spent each year on herbal or complementary nutritional products.

Related Links:
CDC [US] Centers for Disease Control and Prevention