title: Adverse effects associated with arginine alpha-ketoglutarate containing supplements.
abstract: The athletic performance supplement industry is a multibillion-dollar business and one popular category claims to increase nitric oxide (NO) production. We report three patients presenting to the emergency department with adverse effects. A 33-year-old man presented with palpitations, dizziness, vomiting, and syncope, after the use of NO(2) platinum. His examination and electrocardiogram (ECG) were normal. The dizziness persisted, requiring admission overnight. A 21-year-old man with palpitations and near syncope had used a "nitric oxide" supplement. He was tachycardic to 115 bpm with otherwise normal examination. Laboratory values including methemoglobin, and ECG were unremarkable. He was treated with 1 L of saline with no change in heart rate. He was admitted for observation. A 24-year-old man presented after taking NO-Xplode with palpitations and a headache. His examination, laboratory values, and ECG were normal. He was discharged. The purported active ingredient in these products is arginine alpha-ketoglutarate (AAKG), which is claimed to increase NO production by supplying the precursor L-arginine. The symptoms could be due to vasodilation from increased levels of NO, though other etiologies cannot be excluded. AAKG containing supplements may be associated with adverse effects requiring hospital admission.
authors.affiliation: Department of Emergency Medicine and Division of Toxicology, New York City Poison Center, New York University School of Medicine, New York, New York 10016, USA. Jprosser100@gmail.com
authors.forename: J M
authors.initials: JM
authors.lastname: Prosser
authors.forename: N
authors.initials: N
authors.lastname: Majlesi
authors.forename: G M
authors.initials: GM
authors.lastname: Chan
authors.forename: D
authors.initials: D
authors.lastname: Olsen
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: L S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000328:Adult; D001120:Arginine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D002956:Citrulline / Q000378:metabolism; D019587:Dietary Supplements / Q000009:adverse effects*; D004244:Dizziness / Q000139:chemically induced; D004562:Electrocardiography; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007656:Ketoglutaric Acids / Q000009:adverse effects*; D008297:Male; D008706:Methemoglobin / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism; D055815:Young Adult
chemical_list: D007656:Ketoglutaric Acids; C521231:L-arginine alpha-ketoglutarate; D002956:Citrulline; D009569:Nitric Oxide; D008706:Methemoglobin; D001120:Arginine