CureusEnergy Drink-Associated Mixed Liver Injury With Cholestatic Histology After Long-Term High-Volume Consumption: A Case Report

⚠️ Small Study / Early Comparative Evidence

A case report described severe jaundice and mixed biochemical liver injury in a young adult reporting daily consumption of 1-2.5 L of energy drinks for roughly three years. Extensive evaluation excluded major viral, autoimmune, and obstructive causes, though causality remained classified as only a possible association.

Clinical Considerations

• Three years of daily exposure preceded jaundice, elevated bilirubin, and mixed hepatocellular-cholestatic liver injury.
• Liver biopsy demonstrated predominantly cholestatic histology, despite biochemical classification suggesting mixed injury.
• Product formulation and ingredient dosing were unavailable, limiting attribution to caffeine, niacin, or another component.
• Investigators assigned a RUCAM score of 3, supporting only a possible product-level association.

Practice Applications

• Recognize energy drink consumption as a potential exposure during unexplained liver injury evaluations.
• Consider documenting volume, duration, brand, and formulation when obtaining beverage histories.
• Interpret case reports as hypothesis-generating rather than evidence of causality.
• Monitor adolescents and young athletes reporting heavy energy drink intake.