Unexpected side effects from excessive use of energy drinks and opium have been reported by doctors.
In the first of a series of case reports, Dr Jennifer Harb, of the University of Florida College of Medicine, USA, and colleagues tell of a 50 year old man being admitted to an emergency department with acute hepatitis, "most likely due to his intake of 4-5 energy drinks every day for three weeks".
The man presented with malaise, anorexia, abdominal pain, nausea, vomiting, generalised jaundice, and dark urine.
Lab tests showed chronic hepatitis C infection, then liver biopsy showed severe acute hepatitis. Treatment led to complete resolution of symptoms and improvement on lab tests.
"Energy drinks as well as other herbal/over-the-counter supplements should be considered by clinicians in the workup of patients with acute hepatitis," the doctors advise.
The second case report outlines the potential heart risks of multiple bee stings. Professor Prabha Gupta, of the Medical College Hospital, Kerala, India, and her team say the patient developed a prolonged heart block, fainting, and cardiac arrest roughly three weeks after multiple bee stings. He was fitted with a permanent pacemaker.
"We presume that the bee venom caused a profound coronary spasm that caused complete heart block that did not recover," the team state. They add that heart complications requiring urgent action are a possibility in this patient group.
Lastly, Dr Alex Azizi, of the Royal Free London NHS Foundation Trust, UK, describes lead poisoning in a long-term opium smoker.
The patient, a 46-year-old man of Iranian origin, presented with a four-day history of colicky abdominal pain and constipation, after several weeks of irritability and malaise.
"He had smoked 10g of opium per week for a year and a half," Dr Azizi states. The patient’s serum lead concentration was "substantially elevated" and he underwent chelation therapy, which led to a complete recovery.
"This is an important case report of a UK resident describing lead toxicity secondary to the inhalation of opium," Dr Azizi concludes.
All reports appear in BMJ Case Reports today (2 November).
Harb, J. H. et al. A rare cause of acute hepatitis: a common energy drink. BMJ Case Reports 2 November 2016 doi: 10.1136/bcr-2016-216612
Gupta, P. N. et al. Possible complication of bee stings and a review of the cardiac effects of bee stings. BMJ Case Reports 2 November 2016 doi: 10.1136/bcr-2015-213974
Azizi, A. et al. Chronic lead poisoning in an Iranian opium smoker resident in London. BMJ Case Reports 2 November 2016 doi: 10.1136/bcr-2016-215965
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