Supplements Land Thousands in the ER

Dietary supplements linked to thousands of emergency room visits annually

(RxWiki News) Americans are taking more dietary supplements than ever before, and it seems that many are finding themselves in the ER as a result.

A new study from the Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) found that over-the-counter dietary supplements — including multivitamins, energy boosters and diet pills — send an estimated 23,000 Americans to the ER each year. While many of these cases involved children accidentally swallowing supplements or older adults choking on large pills, many involved young adults simply looking to lose weight or stay awake.

"More than one quarter (28 percent) of emergency department visits for supplement-related adverse events in our study involved young adults between the ages of 20 and 34 years," wrote lead study author Andrew I. Geller, MD, a medical officer at the CDC, and colleagues. "Weight-loss or energy products caused more than half these visits, commonly for cardiac symptoms."

According to these researchers, around half of all US adults have used at least one dietary supplement in the past month. The number of supplement products on the market has soared in recent years — from 4,000 in 1994 to more than 55,000 in 2012.

Unlike prescription drugs, the $32 billion supplement industry is largely unregulated. In 1994, the Dietary Supplement Health and Education Act was passed to specifically exempt vitamins and supplements from FDA scrutiny unless problems emerge.

This means that, although the agency can warn against products found to be dangerous, neither safety testing nor FDA approval is required before these products are sold. There also are no requirements that product labels list potential side effects, according to Dr. Geller and colleagues.

For this study, Dr. Geller and team looked at national surveillance data from 63 ERs across the country. From 2004 to 2013, about 3,600 supplement-related ER visits were found. Visits related to energy drinks were excluded from this analysis.

On the basis of those visits, Dr. Geller and team estimated that an average of 23,000 Americans visited the ER and 2,154 were hospitalized each year as a result of supplement use.

Among older adults, swallowing and choking problems caused nearly 40 percent of ER visits. While the FDA limits the size and shape of prescription pills, there are no such requirements for supplements.

Unsupervised children ages 4 and younger who took supplements accounted for more than 21 percent of visits. Child-resistant packaging is not required for dietary supplements, other than those containing iron.

Women accounted for more than half of the ER visits, with weight-loss products causing 30 percent. Weight-loss and energy products also caused nearly 72 percent of ER visits involving cardiac symptoms. More than half of these visits involved adults ages 20 to 34.

These researchers concluded by encouraging health care providers to warn patients of potential side effects of dietary supplements, such as heart problems.

This study was published Oct. 15 in the New England Journal of Medicine.

The US Department of Health and Human Services funded this research. No conflicts of interest were disclosed.

Review Date: 
October 19, 2015