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Poison Centres

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

, , , , , , , & show all
Pages 566-574 | Received 15 Mar 2013, Accepted 25 Jun 2013, Published online: 23 Jul 2013
 

Abstract

Context. Small studies have associated energy drinks—beverages that typically contain high concentrations of caffeine and other stimulants—with serious adverse health events. Objective. To assess the incidence and outcomes of toxic exposures to caffeine-containing energy drinks, including caffeinated alcoholic energy drinks, and to evaluate the effect of regulatory actions and educational initiatives on the rates of energy drink exposures. Methods. We analyzed all unique cases of energy drink exposures reported to the US National Poison Data System (NPDS) between October 1, 2010 and September 30, 2011. We analyzed only exposures to caffeine-containing energy drinks consumed as a single product ingestion and categorized them as caffeine-containing non-alcoholic, alcoholic, or “unknown” for those with unknown formulations. Non-alcoholic energy drinks were further classified as those containing caffeine from a single source and those containing multiple stimulant additives, such as guarana or yerba mate. The data were analyzed for the demographics and outcomes of exposures (unknown data were not included in the denominator for percentages). The rates of change of energy drink-related calls to poison centers were analyzed before and after major regulatory events. Results. Of 2.3 million calls to the NPDS, 4854 (0.2%) were energy drink-related. The 3192 (65.8%) cases involving energy drinks with unknown additives were excluded. Of 1480 non-alcoholic energy drink cases, 50.7% were children < 6 years old; 76.7% were unintentional; and 60.8% were males. The incidence of moderate to major adverse effects of energy drink-related toxicity was 15.2% and 39.3% for non-alcoholic and alcoholic energy drinks, respectively. Major adverse effects consisted of three cases of seizure, two of non-ventricular dysrhythmia, one ventricular dysrhythmia, and one tachypnea. Of the 182 caffeinated alcoholic energy drink cases, 68.2% were < 20 years old; 76.7% were referred to a health care facility. Educational and legislative initiatives to enhance understanding of the health consequences of energy drink consumption were significantly associated with a decreased rate of energy drink-related cases (p = 0.036). Conclusions. About half the cases of energy drink-related toxicity involved unintentional exposures by children < 6 years old. Educational campaigns and legal restrictions on the sale of energy drinks were associated with decreasing calls to poison centers for energy drink toxicity and are encouraged.

Declaration of interest

The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

This work was supported in part by the US Department of Health and Human Services Health Resources and Services Administration, Rockville, MD (HRSA-C76HF15614-10679 Pediatric Integrative Medicine Research Center), the National Center for Toxicological Research (NCTR-E0728711), the National Institutes of Health (NCI-1R01CA127642, NHLBI-1R01HL111459-01, NHLBI-1R01HL109090-01A1) the Laura Coulter-Jones Foundation (Division of Pediatric Clinical Research), and the Batchelor Foundation (Batchelor Children's Research Institute).

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