The annual rate of exposures to dietary supplements increased from 2000-’12, and most occurred in children under 6 years old, an analysis of data from the National Poison Data System showed.

In 2011-’12, about half of U.S. adults reported taking a dietary supplement in the past month.

Previous studies have focused on emergency department visits due to supplement exposures or specific supplements. The aim of this study was to describe the epidemiology of all dietary supplement exposures that were reported to poison control centers from 2000 through 2012.

Demographic information on those exposed was collected as well as reason for and route of exposure, clinical effects, treatment and medical outcome. Those exposed were divided into two age groups: younger than 6 years and 6 years and older.

Supplements were categorized as amino acids, botanicals, cultural medicines, energy products, hormonal products, miscellaneous supplements and other dietary supplements.

The analysis showed 274,998 calls were made to poison control centers regarding dietary supplements during the study period or about 21,154 per year. Seventy percent occurred in children under 6, and nearly all of these were unintentional. Among all age groups, 94% of exposures were acute, and 98% were due to ingestion.

Most of the younger children (91%) did not go to a health care facility but three died. Thirty-one people ages 6 and older also died. Ma huang (ephedra), which was banned by the Food and Drug Administration (FDA) in 2004, was associated with five deaths, multi-botanicals without ma huang or Citrus aurantium with four deaths and cultural medicines with two.

The most common clinical effects included tachycardia, vomiting, nausea, irritability, drowsiness and dizziness.

Most of the serious medical outcomes were linked to energy products, botanicals (especially yohimbe and ma huang) and cultural medicines. Nearly half the exposures to energy products occurred in children younger than 6.

The authors noted that ma huang exposures decreased after it was banned, highlighting the effectiveness of the FDA’s action. “Our results demonstrate the need for FDA regulation of yohimbe and energy products in the US as was done successfully with ma huang products in 2004,” they wrote.