In January of this year, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an updated report on energy drinks based on Drug Abuse Warning Network (DAWN) data. According to the report, energy drink related visits to the ER has increased dramatically as the sales of the products increased. Energy drinks are flavored, sweet drinks that contain added amounts of caffeine and other additives such as guarana (a source of additional caffeine), taurine and ginseng. They are marketed as providing benefits such as increased stamina, and enhanced physical and mental alertness and performance.
Energy drinks have historically been marketed and sold as dietary supplements and are subject to less regulation than caffeinated sodas which are sold and regulated as food. The Generally Regarded As Safe (GRAS) for soda is 71 mg of caffeine per 12 fluid ounces (5.9 mg/ounce). Energy Drinks and shots are able to far exceed that concentration limit by stating the drinks contain dietary supplements.
By way of comparison Table 1 shows the relative concentrations of various Energy Drinks and shots:
Table 1:
| Product Name | Caffeine Content | Fluid Ounce | Caffeine/Ounce |
| 5hr energy | 138 mg | 2 Oz | 69 mg/ounce |
| 5hr energy extra strength | 207 mg | 2 Oz | 103 mg/ounce |
| Monster | 160 mg | 16 Oz | 10 mg/ounce |
| Red Bull | 80 mg | 8 Oz | 10 mg/ ounce |
| Rip It | 200 mg | 16 Oz | 12.5 mg/ounce |
| Rock Star | 160 mg | 16 Oz | 10 mg/ounce |
The graph in Figure one shows the doubling of ER visits related to energy drinks in the past 4 years from 10,000 to over 20,000 visits in 2011 as these supplemented Energy Drinks have gained market share.
Figure 1:
For parents, perhaps most concerning is that up to 11% of the ER patients were under the age of 18. Children are much more susceptible to the effects of the caffeine contained in these products. Children have smaller body mass and because of this, a lesser amount of caffeine (or any drug for that matter) is needed to create the desired effect. Children also have less experience with the effects of caffeine and as such, have less tolerance to the drug.
So what are some of the issues with this increased vulnerability in children?
- Gastrointestinal: Caffeine intoxication can lead to nausea and vomiting
- Cardiovascular problems: Energy drinks can cause increased heart rate, blood pressure and in rare cases, cause the heart to beat abnormally.
- Seizures: in addition to cardiac events, new onset seizures have been reported in both adults and adolescents. The seizures appear to have stopped once the patients abstained from energy drinks.
- Other common signs and symptoms of toxicity that are described from these drinks include: nervousness, anxiety, tremor, jitteriness. The high sugar content in these beverages has also been linked to childhood obesity.
As more data becomes available through what is essentially post-marketing safety surveillance of these products, a recent article in the prestigious journal Pediatrics concluded that energy drinks “are not appropriate for children and adolescents and should never be consumed.”
Best wishes for keeping our families safe and healthy as we move into the sunnier weather of spring,
Until next Tuesday,
