Abstract
Acute pancreatitis is the most common gastrointestinal cause of hospitalization in the United States. Gallstones and alcohol use account for approximately 80 percent of the cases and in remainder the etiology of acute pancreatitis remains unknown. Rare cases of energy drinks as a possible cause of acute pancreatitis have been reported. We report a case of recurrent acute pancreatitis from energy drinks A 19-year-old Caucasian male with Serine Protease Inhibitor Kazal-type 1 (SPINK1) gene mutation had recurrent bouts of acute mild interstitial pancreatitis, 10 admissions in the year of 2017. His presentations include acute onset of deep epigastric pain, lipase level of > 10,000 (u/l). Repeated imaging (Including magnetic resonance imaging with cholangiopancreatography) showed acute mild interstitial pancreatitis without any biliary or additional pancreatic pathology or changes suggestive of chronic pancreatitis. The triglycerides levels ranged from 50 to 77 mg/dL. All episodes responded to conservative management with aggressive fluid resuscitation and pain control without any complications. He was not on any medications or herbal supplement. IgG4 level was 32 mg/dL. He drank Full Throttle (contains taurine, ginseng extract, caffeine, carnitine fumarate, guarana extract) and Red Bull (contains taurine and caffeine) on regular basis. The patient was counselled to abstain from energy drinks. He has not had any recurrence since on 7 months follow-up. Based on strength of association, drugs are considered definite, probable or proposed cause of pancreatitis. Drug is considered as definite cause if patient develops pancreatitis while on the drug, improves on stopping and reoccurs when drug is reintroduced. This case met all the definition's criteria. Additionally, Ayoub et al. reported significant injuries to islet cells and pancreatic acini with energy drinks administration to albino rats. This confirms the biological plausibility of energy drinks causing acute pancreatitis. The mild nature of each of the pancreatitis episode is consistent with drug-induced pancreatitis. Presence of SPINK1 mutation increased this patient's susceptibility to develop acute pancreatitis but it doesn't cause pancreatitis by itself. Energy drinks have definite association with acute pancreatitis and should be discontinued in patients who are at high risk of developing acute pancreatitis such as patient with SPINK1 mutation.