Energy Drinks: The New Eye-Opener For Adolescents
Section snippets
Caffeine
The key ingredient in most energy drinks is caffeine, supplemented by a wide variety of amino acids, B vitamins, and herbal supplements [3]. Caffeine is found in a wide variety of beverages and pharmaceuticals, and has been called the most commonly used psychoactive substance in the world [4]. Major sources in the North American diet include coffee and tea for adults, and carbonated sodas, energy drinks, and chocolate for children and adolescents. A range of caffeine concentrations are found in
Guarana and Other Caffeine-Containing Ingredients
Guarana is derived from the seeds of Paullinia cupana, a South American plant known for its stimulant properties. Guarana contains large amounts of caffeine (4%-8%), theobromine, theophylline, and a high concentration of tannins [11]. Although caffeine concentration may vary widely in guarana preparations, 3 to 5 g of guarana provides approximately 250 mg of caffeine [12]. The effects of guarana ingestion are necessarily similar to caffeine; however, the duration of action may be much longer
Pharmacokinetics of Caffeine
Caffeine, or 1,3,7-trimethylxanthine, is rapidly and completely absorbed after oral ingestion, with nearly 100% bioavailability [34]. Ingested caffeine reaches peak plasma concentration within approximately 30 to 120 minutes, depending on gastric contents. Caffeine is 10% to 35% protein bound and is rapidly redistributed from blood to all tissues [35]. It readily crosses the blood-brain barrier and placenta, and can be found in breast milk 36, 37. Its volume of distribution is 0.61 L/kg [38].
Pharmacology
As a member of the methylxanthine family, caffeine is a structural analog of adenosine and a functional adenosine receptor antagonist [47]. Antagonism at presynaptic alpha-1 receptors leads to an increase in peripheral catecholamine release with subsequent activation of postsynaptic β-adrenergic receptors [48]. The resulting norepinephrine, dopamine, and serotonin release in the brain reverses the centrally mediated adenosine effects of sedation and anticonvulsant activity [6]. Caffeine also
Clinical Manifestations, Toxicity
In 2005, more than 4600 calls were made to the American Association of Poison Control Centers (Washington, DC) for questions regarding caffeine. Of those, 2600 involved patients younger than 19 years, and 2345 required treatment in a health care facility. There were no deaths attributed to caffeine in 2004 or 2005 50, 51. There are no available data on the proportion of these calls credited to energy drink use.
Most caffeine intoxications are mild; adverse effects, such as nausea and
Laboratory Findings
Hypokalemia is the sine qua non laboratory abnormality in caffeine intoxication. The presentation of vomiting, tachycardia, and hypokalemia should prompt a search for methylxanthine or other β-agonist exposure (ie, albuterol, clenbuterol). Hyperglycemia is common in caffeine toxicity, secondary to increased lipolysis, glycogenolysis, and gluconeogenesis [77]. Leukocytosis, mild metabolic acidosis, ketonuria, hypophosphatemia, and hypocalcemia have also been described [61].
Qualitative testing
Management
Treatment of patients with caffeine toxicity must begin with careful and immediate assessment of the patient's airway, breathing, and circulation. Intravenous access must be established and noninvasive monitoring devices used. Oxygen should be administered if necessary, and a fingerstick glucose level should be rapidly obtained. Serum electrolytes, including calcium and phosphorus, should be obtained. Serial electrocardiograms are indicated in any patient with palpitations, chest pain, or vital
Future Research
Several areas require investigation to further characterize the effects of long-term energy drink use in children and adolescents. One of the most worrisome is the combination of energy drinks with alcohol. Urban legend and pop culture have contributed to the mystique that energy drinks may prevent the depressant effects of intoxication when consumed with alcohol [99]. Instead, a recent study described no change in alcohol effects when combined with energy drinks [100]. The potential risk for
Summary
Clinicians should screen for energy drink use among their patients. Screening can identify symptoms related to toxicity and give patients greater understanding of the risks of high-dose and long-term energy drink use. When caffeine toxicity is suspected, immediate consultation with a regional poison control center or toxicologist is recommended. Clinicians should report all suspected cases of energy drink toxicity to a poison control center because the pooled data generated by poison control
Acknowledgments
The authors gratefully acknowledge the assistance of Dr Edward W. Boyer and Mr William B. Hendee in the preparation of the manuscript.
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2020, Journal of Emergency MedicineCaffeinated energy drink consumption and predictors of use among secondary school students over time in the COMPASS cohort study
2019, Preventive Medicine ReportsCitation Excerpt :Caffeinated energy drinks (CEDs) commonly contain a moderate to high level of caffeine, stimulating herbal supplements, and sugar or sugar derivatives (McCusker et al., 2006; Health Canada, 2015a). Evidence suggests that within the CED market, nearly half of consumers are 25 years of age or younger (Pomeranz et al., 2013; Babu et al., 2008; Clauson et al., 2008). While Health Canada recommends limiting daily caffeine intake among adolescents to ≤2.5 mg/kg body weight, it has been reported that the typical CED available in the Canadian market contains between 80 and 180 mg of caffeine (Health Canada, 2013; Health Canada, 2015b).
Energy drink consumption among German adolescents: Prevalence, correlates, and predictors of initiation
2019, AppetiteCitation Excerpt :Energy drinks (ED) are beverages that contain high levels of caffeine in combination with other ingredients such as amino acids, sugars or sweeteners, guarana, taurine, ginseng, l-carnitine, herbal supplements, and B vitamins (Babu, Church, & Lewander, 2008; McCusker, Goldberger, & Cone, 2006; Reissig, Strain, & Griffiths, 2009; Seifert, Schaechter, Hershorin, & Lipshultz, 2011).