N Engl J Med

Background:Dietary supplements, such as herbals/complementary nutritionals and micronutrients (vitamins/minerals), are commonly used in the U.S., yet national data on adverse effects are limited.Methods:We used a nationally representative stratified probability sample of 63 emergency departments (2004\u20132013) to describe U.S. emergency department visits for dietary supplement adverse events.Results:Based on 3,667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611\u201327,398) emergency department visits, resulting in 2,154 (CI, 1,342\u20132,967) hospitalizations, were attributed to adverse events from supplements annually. Emergency department visits for supplement adverse events commonly involved young adults aged 20\u201334 years (28.0%; CI, 25.1% 1230.8%) and unsupervised children (21.2%; CI, 18.4% 1224.0%). Excluding unsupervised child ingestions, 65.9% (CI, 63.2% 1268.5%) of emergency department visits for single-supplement adverse events involved herbals/complementary nutritionals; 31.8% (CI, 29.2% 1234.3%) involved micronutrients. Herbal/complementary nutritional products for weight loss (25.5%; CI, 23.1% 1227.9%) and increased energy (10.0%; CI, 8.0% 1211.9%) were commonly implicated. These weight loss or energy products caused 71.8% (CI, 67.6% 1276.1%) of supplement adverse events involving palpitations, chest pain, and/or tachycardia, and 58.0% (CI, 52.2% 1263.7%) involved persons aged 20\u201334 years. Among adults aged 6565 years, choking or pill-induced dysphagia/globus caused 37.6% (CI, 29.1% 1246.2%) of all emergency department visits for supplement adverse events; micronutrients were implicated in 83.1% (CI, 73.3% 1292.9%) of these visits.Conclusions:Over 20,000 emergency departments visits in the US annually are attributed to dietary supplement adverse events; these commonly involve cardiovascular manifestations from weight loss or energy products in younger adults, micronutrient ingestions by unsupervised children, and swallowing problems, usually from micronutrients, in older adults.CC999999/Intramural CDC HHS/United States2018-10-22T00:00:00Z26465986PMC6196363vault:3101