title: An analysis of energy-drink toxicity in the National Poison Data System.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Seifert
authors.forename: Steven A
authors.initials: SA
authors.lastname: Seifert
authors.forename: Judy L
authors.initials: JL
authors.lastname: Schaechter
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Bronstein
authors.forename: Blaine E
authors.initials: BE
authors.lastname: Benson
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Hershorin
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: Vivian I
authors.initials: VI
authors.lastname: Franco
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
mesh_terms: D000293:Adolescent; D000328:Adult; D000434:Alcoholic Beverages / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D002110:Caffeine / Q000506:poisoning*; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003257:Consumer Product Safety; D016208:Databases, Factual; D061215:Energy Drinks / Q000506:poisoning*; D005247:Feeding Behavior; D005260:Female; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D011041:Poisoning / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine