Non-Viral Hepatitis Cases Possibly Linked to Bottled Alkaline Water

Non-Viral Hepatitis Cases Possibly Linked to Bottled Alkaline Water

The FDA, along with the CDC and the Southern Nevada Health District is investigating a number of reports of acute non-viral hepatitis in the state of Nevada.

“The FDA is committed to protecting the health of Americans and is especially concerned when there is a food safety issue impacting our youngest, and some of the most vulnerable in the population – infants and young children.

Upon learning about reports of acute non-viral hepatitis in Nevada, impacting five young children, the FDA quickly activated a team to further investigate. We are working closely with the CDC, state and local partners to complete our investigation and monitor for any additional illnesses,” – FDA said.

Non-Viral Hepatitis Cases

On March 13, the FDA was alerted to five cases of acute non-viral hepatitis (resulting in acute liver failure) in infants and children that occurred in November 2020 with an unknown cause reported to the Southern Nevada Health District. All five patients had been hospitalized but have since recovered. All patients were reported to have consumed “Real Water” brand alkaline water. These patients came from four different households. Five additional people, two adults and three children, from two of the four households were reported to have experienced other symptoms as well. Less severe symptoms included fever, vomiting, nausea, loss of appetite, and fatigue.

Non-viral hepatitis is an inflammation of the liver that can cause scarring on the liver (cirrhosis), liver cancer, liver failure and death. There are 3 types of non-viral hepatitis:

  • Toxic hepatitis is caused by chemicals, drugs (prescription and over-the-counter) and nutritional supplements.
  • Alcoholic hepatitis is caused by drinking too much alcohol, which harms the liver. See a doctor if you have symptoms of alcoholic hepatitis or if you can’t control your drinking. Your doctor can help you find ways to stop.
  • Autoimmune hepatitis is caused by the immune system attacking the liver. The immune system can attack the liver for unknown reasons, causing inflammation, liver scarring, liver cancer and liver failure. Some diseases and certain toxic substances and drugs can cause this to happen.

To treat your symptoms, your doctor may prescribe a drug (corticosteroid) to reduce liver inflammation, or you may need to be treated in a hospital.


The consumption of “Real Water” brand alkaline water is the only common link identified among all of these cases to date. This brand of alkaline water is owned by Real Water Inc., headquartered in Mesa, Arizona.

Although the investigation is ongoing, epidemiologic information currently indicates that this alkaline water product may be the cause of the illnesses. FDA is in the beginning stages of this investigation, and there may be additional products connected to this outbreak. FDA has initiated an investigation at the firm. As this outbreak investigation continues, the FDA will provide additional updates to this advisory as more information becomes available.

“Consumers, restaurants, and retailers should not drink, cook with, sell, or serve “Real Water” alkaline water, until more information is known about the cause of the illnesses.

Symptoms of all types of hepatitis, including non-viral hepatitis, are similar and can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay or gray-colored bowel movements, joint pain, yellow eyes, and jaundice. Those experiencing these symptoms should contact their doctor,” – recommends FDA.

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