Over the counter nutritional supplements: Implications for critically ill patients

Dietary supplements are increasingly viewed by the public as a safe and acceptable complement to conventional medical therapies. Because these therapies are available over the counter, they are frequently used without a treating physician’s knowledge or approval. This situation is problematic as many of these agents have a well-established potential for adverse effects. Commonly reported syndromes attributable to dietary supplement use include cardiovascular effects, central nervous system alterations, hepatotoxicity, bleeding complications, and drug-drug interactions, among others. In particularly vulnerable populations – including the critically ill – the occult presence of these agents may contribute to adverse events and unfavorable outcomes. Accordingly, this chapter will review the potential complications arising from the use of dietary supplements in patients who subsequently require intensive care unit support.