An analysis of energy-drink toxicity in the National Poison Data System

STEMI Associated with Overuse of Energy Drinks

Coronary artery disease (CAD) and ST-elevation myocardial infarction (STEMI) are predominantly diseases of middle-aged and older adults and when found in younger adults are usually associated with a strong family history. However, this report details the case of a nonobese 26-year-old Hispanic male who presented with an acute STEMI despite having no family history or other apparent risk factors for CAD or STEMI beyond a two pack-year smoking history and excessive energy drink consumption. The patient reported consuming between eight and ten 473 mL cans per day. Cardiac catheterization subsequently confirmed total occlusion of his left circumflex coronary artery.

Sports and energy drink consumption are linked to health-risk behaviours among young adults

OBJECTIVE

National data for the USA show increases in sports and energy drink consumption over the past decade with the largest increases among young adults aged 20-34 years. The present study aimed to identify sociodemographic factors and health-risk behaviours associated with sports and energy drink consumption among young adults.

DESIGN

Cross-sectional analysis of survey data from the third wave of a cohort study (Project EAT-III: Eating and Activity in Teens and Young Adults). Regression models stratified on gender and adjusted for sociodemographic characteristics were used to examine associations of sports and energy drink consumption with eating behaviours, physical activity, media use, weight-control behaviours, sleep patterns and substance use.

SETTING

Participants completed baseline surveys in 1998-1999 as students at public secondary schools in Minneapolis/St. Paul, Minnesota, USA and the EAT-III surveys online or by mail in 2008-2009.

SUBJECTS

The sample consisted of 2287 participants (55% female, mean age 25·3 years).

RESULTS

Results showed 31·0% of young adults consumed sports drinks and 18·8% consumed energy drinks at least weekly. Among men and women, sports drink consumption was associated with higher sugar-sweetened soda and fruit juice intake, video game use and use of muscle-enhancing substances like creatine (P≤0·01). Energy drink consumption was associated with lower breakfast frequency and higher sugar-sweetened soda intake, video game use, use of unhealthy weight-control behaviours, trouble sleeping and substance use among men and women (P<0·05).

CONCLUSIONS

Health professionals should consider the clustering of sports and energy drink consumption with other unhealthy behaviours in the design of programmes and services for young adults.

Ventricular dysrhythmias associated with poisoning and drug overdose: a 10-year review of statewide poison control center data from California

BACKGROUND

Ventricular dysrhythmias are a serious consequence associated with drug overdose and chemical poisoning. The risk factors for the type of ventricular dysrhythmia and the outcomes by drug class are not well documented.

OBJECTIVE

The aim of this study was to determine the most common drugs and chemicals associated with ventricular dysrhythmias and their outcomes.

METHODS

We reviewed all human exposures reported to a statewide poison control system between 2002 and 2011 that had a documented ventricular dysrhythmia. Cases were differentiated into two groups by type of arrhythmia: (1) ventricular fibrillation and/or tachycardia (VT/VF); and (2) torsade de pointes (TdP).

RESULTS

Among the 300 potential cases identified, 148 cases met the inclusion criteria. Of these, 132 cases (89%) experienced an episode of VT or VF, while the remaining 16 cases (11%) had an episode of TdP. The most commonly involved therapeutic classes of drugs associated with VT/VF were antidepressants (33/132, 25%), stimulants (33/132, 25%), and diphenhydramine (16/132, 12.1%). Those associated with TdP were antidepressants (4/16, 25%), methadone (4/16, 25%), and antiarrhythmics (3/16, 18.75%). Drug exposures with the greatest risk of death in association with VT/VF were antidepressant exposure [odds ratio (OR) 1.71; 95% confidence interval (CI) 0.705-4.181] and antiarrhythmic exposure (OR 1.75; 95% CI 0.304-10.05), but neither association was statistically significant. Drug exposures with a statistically significant risk for TdP included methadone and antiarrhythmic drugs.

CONCLUSIONS

Antidepressants and stimulants were the most common drugs associated with ventricular dysrhythmias. Patients with suspected poisonings by medications with a high risk of ventricular dysrhythmia warrant prompt ECG monitoring.

Can energy drinks increase the desire for more alcohol?

Energy drinks, the fastest growing segment in the beverage market, have become popular mixers with alcohol. The emerging research examining the use of alcohol mixed with energy drinks (AmEDs) indicates that the combination of caffeine-containing energy drinks with alcohol may be riskier than the use of alcohol alone. The public health concerns arising from AmED use are documented in different research domains. Epidemiologic studies reveal that the consumption of AmEDs is frequent among young and underage drinkers, demographic groups that are more likely to experience the harms and hazards associated with alcohol use. In addition, for all consumers, elevated rates of binge drinking and risk of alcohol dependence have been associated with AmED use when compared to alcohol alone. Results from laboratory studies help explain why AmED use is associated with excessive intake of alcohol. When an energy drink (or caffeine) is combined with alcohol, the desire (or urge) to drink more alcohol is more pronounced in both humans and animals than with the same dose of alcohol alone. The experience of drinking alcohol appears to be more rewarding when combined with energy drinks. Given that caffeine in other foods and beverages increases preference for those products, further research on AmEDs may elucidate the underlying mechanisms that contribute to alcohol dependence.

Energy drinks and their adverse health effects: A systematic review of the current evidence

PURPOSE

With the rising consumption of so-called energy drinks over the last few years, there has been a growing body of literature describing significant adverse health events after the ingestion of these beverages. To gain further insight about the clinical spectrum of these adverse events, we conducted a literature review.

METHODS

Using PubMed and Google-Scholar, we searched the literature from January 1980 through May 2014 for articles on the adverse health effects of energy drinks. A total of 2097 publications were found. We then excluded molecular and industry-related studies, popular media reports, and case reports of isolated caffeine toxicity, yielding 43 reports.

CONCLUSION

Energy drink consumption is a health issue primarily of the adolescent and young adult male population. It is linked to increased substance abuse and risk-taking behaviors. The most common adverse events affect the cardiovascular and neurological systems. The most common ingredient in energy drinks is caffeine, and it is believed that the adverse events are related to its effects, as well as potentiating effects of other stimulants in these drinks. Education, regulation, and further studies are required.

Caffeine intake from food and beverage sources and trends among children and adolescents in the United States: review of national quantitative studies from 1999 to 2011

There is increasing concern about potential adverse effects of caffeine in children. Our understanding of caffeine intake relies on studies dating to the late 1990s. This article synthesizes information from national studies since then to describe caffeine consumption, its association with sociodemographic factors, key dietary sources including caffeine-containing energy drinks (CCEDs), and trends in caffeine intake and sources among US children. Findings from the Kanter Worldpanel (KWP) Beverage Consumption Panel and the NHANES showed that caffeine consumption prevalence was generally consistent across studies and over time; more than one-half of 2- to 5-y-olds and ∼75% of older children (>5 y) consumed caffeine. The usual intakes of caffeine were 25 and 50 mg/d for children and adolescents aged 2-11 and 12-17 y, respectively (NHANES 2007-2010). Caffeine consumption correlated with age and was higher in non-Hispanic white children. The key sources of caffeine were soda and tea as well as flavored dairy (for children aged <12 y) and coffee (for those aged ≥12 y). The frequency of CCED use varied (2-30%) depending on study setting, methods, and demographic characteristics. A statistically significant but small decline in caffeine intake was noted in children overall during the 10- to 12-y period examined; intakes remained stable among older children (≥12 y). A significant increasing trend in CCED and coffee consumption and a decline in soda intake were noted (1999-2010). In 2009-2010, 10% of 12- to 19-y-olds and 10-25% of caffeine consumers (aged 12-19 y) had intakes exceeding Canadian maximal guidelines. Continued monitoring can help better understand changes in caffeine consumption patterns of youth.

Poisoning in the United States: 2012 emergency medicine report of the National Poison Data System

Deaths from drug overdose have become the leading cause of injury death in the United States, where the poison center system is available to provide real-time advice and collect data about a variety of poisonings. In 2012, emergency medical providers were confronted with new poisonings, such as bath salts (substituted cathinones) and Spice (synthetic cannabinoid drugs), as well as continued trends in established poisonings such as from prescription opioids. This article addresses current trends in opioid poisonings; new substances implicated in poisoning cases, including unit-dose laundry detergents, bath salts, Spice, and energy drinks; and the role of poison centers in public health emergencies such as the Fukushima radiation incident.

Energy drink consumption in europe: a review of the risks, adverse health effects, and policy options to respond

With the worldwide consumption of energy drinks increasing in recent years, concerns have been raised both in the scientific community and among the general public about the health effects of these products. Recent studies provide data on consumption patterns in Europe; however, more research is needed to determine the potential for adverse health effects related to the increasing consumption of energy drinks, particularly among young people. A review of the literature was conducted to identify published articles that examined the health risks, consequences, and policies related to energy drink consumption. The health risks associated with energy drink consumption are primarily related to their caffeine content, but more research is needed that evaluates the long-term effects of consuming common energy drink ingredients. The evidence indicating adverse health effects due to the consumption of energy drinks with alcohol is growing. The risks of heavy consumption of energy drinks among young people have largely gone unaddressed and are poised to become a significant public health problem in the future.

Caffeine intake in children in the United States and 10-y trends: 2001-2010

BACKGROUND

Because of the increasing concern of the potential adverse effects of caffeine intake in children, recent estimates of caffeine consumption in a representative sample of children are needed.

OBJECTIVES

We provide estimates of caffeine intake in children in absolute amounts (mg) and in relation to body weight (mg/kg) to examine the association of caffeine consumption with sociodemographic factors and describe trends in caffeine intake in children in the United States.

DESIGN

We analyzed caffeine intake in 3280 children aged 2-19 y who participated in a 24-h dietary recall as part of the NHANES, which is a nationally representative survey of the US population with a cross-sectional design, in 2009-2010. Trends over time between 2001 and 2010 were examined in 2-19-y-old children (n = 18,530). Analyses were conducted for all children and repeated for caffeine consumers.

RESULTS

In 2009-2010, 71% of US children consumed caffeine on a given day. Median caffeine intakes for 2-5-, 6-11-, and 12-19-y olds were 1.3, 4.5, and 13.6 mg, respectively, and 4.7, 9.1, and 40.6 mg, respectively, in caffeine consumers. Non-Hispanic black children had lower caffeine intake than that of non-Hispanic white counterparts. Caffeine intake correlated positively with age; this association was independent of body weight. On a given day, 10% of 12-19-y-olds exceeded the suggested maximum caffeine intake of 2.5 mg/kg by Health Canada. A significant linear trend of decline in caffeine intake (in mg or mg/kg) was noted overall for children aged 2-19 y during 2001-2010. Specifically, caffeine intake declined by 3.0 and 4.6 mg in 2-5- and 6-11-y-old caffeine consumers, respectively; no change was noted in 12-19-y-olds.

CONCLUSION

A majority of US children including preschoolers consumed caffeine. Caffeine intake was highest in 12-19-y-olds and remained stable over the 10-y study period in this age group.

Energy drink-induced near-fatal ventricular arrhythmia prevented by an intracardiac defibrillator decades after operative "repair" of tetralogy of Fallot

We describe a 45-year old man who experienced a potentially fatal arrhythmia after consumption of multiple energy drinks. At 5 years old, he underwent "repair" of tetralogy of Fallot using a patch in the right ventricular outflow tract, and at age 40 had an automatic implantable cardiac defibrillator (AICD) placed. His first AICD shock occurred within 30 minutes after he finished the third energy drink and was preceded by feelings of lightheadedness and severe dizziness. Without the AICD, he likely would have died. The risk of consuming energy drinks in those with underlying structural heart disease and the general population should be determined. Warning labels should be required to inform consumers of the risks posed by these drinks and of appropriate limits for consumption.

Review of the energy drink literature from 2013: findings continue to support most risk from mixing with alcohol

PURPOSE OF REVIEW

In the field of caffeine research, interest in and concern for energy drink consumption have grown. Most caffeine-related research studies published in 2013 focused on energy drink consumption. This article reviews this literature.

RECENT FINDINGS

Prevalence of energy drink consumption varies by measure and age group. Lack of a standardized definition of use inhibits comparison across studies. Studies reviewed show that energy drink consumption is generally low, but the minority who drink the most may be consuming at unsafe levels. Energy drinks are popular among adolescents and young adults. They boost energy and alertness in some conditions, but may have adverse hemodynamic effects. Harmful consequences, including involvement in risky driving, riding with an intoxicated driver and being taken advantage of sexually, were reported significantly more often by adolescents and young adults who combined energy drinks with alcohol compared with those who did not.

SUMMARY

This review of recent literature focused on prevalence, motivation, and consequences of energy drink use. Clear findings emerged only on the dangers of mixing alcohol and energy drinks. The lack of a standardized measure made the comparison across studies difficult. Future research should extend and clarify these findings using standardized measures of use.

Subjective State, Blood Pressure, and Behavioral Control Changes Produced by an "Energy Shot"

Background: Energy drinks and energy shots are popular consumer beverages that are advertised to increase feelings of alertness. Typically, these products include high levels of caffeine, a mild psychostimulant drug. The scientific evidence demonstrating the specific benefits of energy products to users in terms of subjective state and objective performance is surprisingly lacking. Moreover, there are rising health concerns associated with the use of these products. Therefore, the purpose of this study was to investigate the acute effects of a popular energy shot (5-Hour Energy^®) on subjective and objective measures that were assessed hourly for 6 hours following consumption. Methods: Participants (n=14) completed a three-session study where they received the energy shot, a placebo control, and no drink. Following dose administration, participants completed subjective Profile of Mood States ratings hourly for 6 hours. Participants also repeatedly completed a behavioral control task (the cued go/no-go task) and provided blood pressure and pulse rate readings at each hour. Results: Consumption of the energy shot did improve subjective state, as measured by increased ratings of vigor and decreased ratings of fatigue. However, the energy shot did not alter objective performance, which worsened over time. Importantly, the energy shot elevated both systolic and diastolic blood pressure. Conclusions: Consumption of one energy shot may only result in modest benefits to subjective state. Individuals with preexisting hypertension or other medical conditions should be cautious about using these new consumer products.

Characteristics of US Health Care Providers Who Counsel Adolescents on Sports and Energy Drink Consumption

Objective. To examine the proportion of health care providers who counsel adolescent patients on sports and energy drink (SED) consumption and the association with provider characteristics. Methods. This is a cross-sectional analysis of a survey of providers who see patients ≤17 years old. The proportion providing regular counseling on sports drinks (SDs), energy drinks (EDs), or both was assessed. Chi-square analyses examined differences in counseling based on provider characteristics. Multivariate logistic regression calculated adjusted odds ratios (aOR) for characteristics independently associated with SED counseling. Results. Overall, 34% of health care providers regularly counseled on both SEDs, with 41% regularly counseling on SDs and 55% regularly counseling on EDs. On adjusted modeling regular SED counseling was associated with the female sex (aOR: 1.44 [95% CI: 1.07–1.93]), high fruit/vegetable intake (aOR: 2.05 [95% CI: 1.54–2.73]), family/general practitioners (aOR: 0.58 [95% CI: 0.41–0.82]) and internists (aOR: 0.37 [95% CI: 0.20–0.70]) versus pediatricians, and group versus individual practices (aOR: 0.59 [95% CI: 0.42–0.84]). Modeling for SD- and ED-specific counseling found similar associations with provider characteristics. Conclusion. The prevalence of regular SED counseling is low overall and varies. Provider education on the significance of SED counseling and consumption is important.

Poisoning in korean children and adolescents

Drug intoxication in children and adolescents is not uncommon in Korea. But the tendency of intoxication is changing with some factors, such as national surveillance system, Naderism and increasing concern among physicians. But the death rate of intoxication among adolescents is increasing in spite of decreasing total death rate of intoxication among children and adolescents. Therefore the physician must be concerned about the basic management of intoxication and figure out the common toxic substance among children and adolescents.