S5609 Unusual Case of Severe Alcoholic Hepatitis Complicated by an Energy Drink

Introduction: Popular for their caffeine boost, energy drinks raise concerns due to additives and supplements. High in caffeine, taurine, and B-vitamins, they can pose risks, such as niacin toxicity, even at lower doses. We present a 35-year-old man who increased his alcohol intake and consumed one can of Monster daily. He experienced non-bloody vomiting, and tests revealed severe alcoholic hepatitis linked to his energy drink use. Favorably, after stopping alcohol and energy drinks and starting corticosteroid therapy, he made a remarkable recovery, with lab values returning to almost normal. This case underscores the need to screen for energy drink use, particularly in those with alcohol history or liver issues, to identify risks early and promote health. Case Description/Methods: A 35-year-old man with a history of alcohol use disorder presented with abdominal pain and headache after 10 days of consuming 25-30 bottles of alcohol daily and one can (473 ml) of Monster energy drink daily for 10 years. He exhibited epigastric tenderness. Labs showed elevated ALK PHOS 250, alanine aminotransferase (ALT) 2,812, aspartate aminotransferase (AST) 3,910, total bilirubin 3.4, PT 24.7, and international normalized ratio 2.16, with an alcohol level of 277. Other tests, including viral serologies and a computed tomography (CT) scan, were unremarkable. The patient was treated in MICU with N-Acetylcysteine, steroids, intravenous fluids, on CIWA-Ar protocol, and improved significantly. Discharged on oral prednisone 40 mg daily for 28 days, he returned for follow-up 2 months later, reporting abstinence from alcohol and energy drinks. His labs showed significant improvement: ALT 81, AST 66, total bilirubin 0.2, and albumin 4.5. Discussion: The trend of energy drinks raises significant health concerns, especially when combined with alcohol. We recently encountered a patient whose transaminase levels spiked after consuming Monster energy drinks and alcohol. Research indicates that mixing these drinks often leads to higher alcohol consumption, as seen in our case. Energy drinks contain ingredients like caffeine, taurine, and niacin (vitamin B3). Excessive intake (above 1.5 grams) of Niacin poses risks to liver. Many Monster energy drinks exceed this limit, raising concerns about liver toxicity. An FDA report from 2004 to 2012 highlights severe adverse effects from energy drinks, such as hepatitis and fatalities in extreme cases. Our patient recovered well with steroid treatment and intravenous fluids. It's essential to raise awareness about the risks of energy drinks to promote healthier choices and better overall well-being.