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Why Dietary Supplements Send Patients to the ED

ATLANTA – It might come as a surprise to dietary supplement advocates who believe they always are perfectly safe, but the lightly regulated products send more than 20,000 users to the emergency department each year.

A special article published recently in The New England Journal of Medicine suggests that, from 2004 through 2013, dietary supplements were implicated in an average of 23,000 ED visits and 2,000 hospitalizations annually.

“Although the numbers of emergency department (ED) visits and hospitalizations were less than 5% of the numbers that have been reported for pharmaceutical products previously, dietary supplements are regulated and marketed under the presumption of safety,” write researchers from the CDC.

ED physicians likely have noticed how many of the patients presenting with supplement-related adverse reactions are between 20 and 34. In fact, 28% of ED visits related to supplement use are by young adults, who are considered least likely to have problems with the products, according to the study.

The worst offenders? Weight-loss or energy compounds. Users often come to the ED because of cardiac symptoms such as palpitations, chest pain, or tachycardia.

“Notably, cardiac symptoms were documented more frequently in emergency department visits for adverse events associated with weight loss (43%) and energy products (46%) than for prescription stimulants,” study authors point out, adding that a previous study found that only 23% of ED visits were related to prescription stimulants.

The elderly and children, who are considered most vulnerable to side effects, also regularly present with the ED with supplement-related problems.

For children, unsupervised ingestion is responsible for more than 21% of all estimated ED visits for supplement-related adverse events. Products most commonly involved are multivitamins (33.6%), iron supplements (11.8%), supplements for weight loss (10.4%) and supplements for sleep, sedation, or anxiolysis (8.8%).

Older adults aren’t exempt from adverse reactions either. For them, swallowing problems caused nearly 40% of ED visits related to supplements. Micronutrients were implicated in more than 80% of those visits.

The study notes that, while the FDA recommends limiting the size of pharmaceutical tablets to 22 mm and requires the reporting of tablet size and shape on abbreviated new-drug applications, no similar size recommendations or similar reporting requirements exist for dietary supplements.

“Large amounts or multiple types of micronutrients are often packaged in a single large pill, and many micronutrient products approaching or exceeding 22 mm are commercially available,” the study authors write, adding, “Considerations for reducing the number of emergency department visits for swallowing problems include decreasing the size of supplement pills or using other delivery vehicles (e.g., liquids, gels, or powders), particularly for micronutrients for older adults, along with educating patients on methods for avoiding swallowing problems."

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