Suspected Energy Drink–Induced Acute Coronary Syndrome With Sudden Cardiac Arrest

Interventional therapy of coronary artery disease in China: retrospective and perspective

A STUDY TO ASSESS THE PATTERN OF CONSUMPTION AND AWARENESS REGARDING USE OF CAFFEINE AND ENERGY DRINKS AMONG NURSING STUDENTS IN SELECTED NURSING COLLEGE AT DEHRADUN, UTTARAKHAND

Energy drink consumption and marketing in South Africa

1. Kwabena L. Blankson, MD* 2. Amy M. Thompson, DO† 3. Dale M. Ahrendt, MD‡ 4. Vijayalakshmy Patrick, MD§ 1. *Maj, US Air Force, Adolescent Medicine, Naval Medical Center, Portsmouth, VA. 2. †Maj, US Army, Adolescent Medicine Fellow, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX. 3. ‡Lt Col, US Air Force, Program Director, Adolescent Medicine, Fellowship, SAUSHEC, San Antonio, TX. 4. §Psychiatrist, Brooke Army Medical Center Associate Professor, University of Texas Health Science Center, San Antonio, TX. Hundreds of different energy drinks are available and are marketed to adolescents, carrying the potential for substance abuse that involves caffeine and alcohol. Clinicians must be educated to deal with their patients’ use of these products. After reading this article, readers should be able to: 1. Understand the size and scope of the energy drink market and recognize common energy drink brands. 2. Know that adolescents are high consumers of energy drinks and use them as performance enhancers. 3. Know the contents of energy drinks and their adverse effects and safety concerns. 4. Know that energy drinks can be a cause of tachycardia, hypertension, obesity, and other medical problems in adolescents. 5. Know the dangers of mixing energy drinks with alcohol. 6. Understand the relationship between caffeine tolerance/dependence and alcohol tolerance/dependence. 7. Understand the importance of screening teenagers for energy drink use in the office setting and offering appropriate counseling. Energy drinks are caffeinated beverages advertised as boosting the immune system, enhancing performance, and creating a “buzz” or a “high.” Some of these drinks contain alcohol, and sometimes consumers mix them with alcoholic beverages. This article reviews current information about the content, benefits, and risks of the use of these energy drinks by adolescents. Adolescents are no strangers to energy drinks, and over the past 2 years, media reports have heightened the awareness of doctors, parents, and lawmakers. In 2010, nine university students in Washington State were hospitalized and one almost died; their illness was attributed to a fruit-flavored, caffeinated alcoholic drink. A month earlier, on a college campus in New Jersey, 23 students were hospitalized after becoming intoxicated, again reportedly after drinking the same …

Out-of-hospital cardiac arrest (OHCA) is a common initial presentation of cardiovascular disease, affecting up to 325 000 people in the United States each year.1 In a recent meta-analysis of >140 000 patients with OHCA, survival to hospital admission was 23.8%, and survival to hospital discharge was only 7.6%.2 In patients who initially achieve return of spontaneous circulation (ROSC) after OHCA, the significant subsequent morbidity and mortality are due largely to the cerebral and cardiac dysfunction that accompanies prolonged whole-body ischemia. This syndrome, called the post cardiac arrest syndrome, comprises anoxic brain injury, post cardiac arrest myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology3,4 (Table 1). The contribution of each of these components in an individual patient depends on various factors, including prearrest comorbidities, duration of the ischemic insult, and cause of the cardiac arrest. This review focuses on therapeutic strategies and recent developments in managing patients who are initially resuscitated from cardiac arrest. View this table: Table 1. Post Cardiac Arrest Syndrome: Pathophysiology and Potential Treatment Strategies There are 3 major aspects that require consideration in the management of the post cardiac arrest patient. After resuscitation, a decision must be made in relation to the appropriate triage of the OHCA patient. The next phase of management concerns the in-hospital treatment, which must address each component of the postarrest syndrome as appropriate for the individual patient. Finally, there are issues relating to prognostication and the deployment of various secondary prevention measures. Our recommended treatment algorithm is summarized in the Figure. This ideally follows from the implementation of basic and advanced life support measures, including effective cardiopulmonary resuscitation and defibrillation when appropriate, which are major determinants of outcome.2 Such an approach to care may be further modified according to the presence of other comorbidities and precipitating factors, which should be assessed …

Sudden cardiac arrest occurring in temporal proximity to consumption of energy drinks

Consumption of energy drinks (ED) raises concerns because of adverse health effects possibly linked with high levels of caffeine and sugar intake. The study looks at the scope of ED consumption as well as some of the associated characteristics. Thirty-six public colleges in the Canadian province of Québec agreed to participate in a descriptive cross-sectional study (n = 36). In February 2013, participating colleges invited their students to answer an online questionnaire on consumption of ED, alcoholic ED (AED), and ED in combination with other psychotropic drugs. A descriptive and correlational analysis was carried out. Logistic regressions explored associations between ED consumption and associated characteristics. Of the students who successfully completed the questionnaire and participated in the study (n = 10,283), a low proportion consumed ED (9.1%; n = 935) and/or AED (1.1%; n = 109) at least once a week in the previous month. Although low in proportion, a number of participants reported having used ED with other stimulant psychoactive substances (n = 247) and ≥3 ED/day (n = 193) or ≥3 AED/occasion (n = 167), which can pose a risk for serious adverse effects. Weekly ED consumption was associated with consumption of ≥20 cups of coffee/week, smoking, excessive use of alcohol and past use of cannabis, glues or solvents and amphetamines. A majority of respondents are not heavy users of ED, AED, or ED with drugs. Yet, the profiles of ED consumption potentially harmful to health that characterize some participants indicate that the potential health consequences of such behaviour are of concern.

OBJECTIVES: We aim to investigate the knowledge towards Energy Drinks (EDs) consumption and related factors among young male athletes in the United Arab Emirates (UAE).
 
 SUBJECTS & METHODS: A cross-sectional study included 688 young male athletes from Al Ain sports club aged between 7 to 18 years. Data were collected using a modified version of a validated questionnaire from the European Food Safety Authority.
 
 RESULTS: Overall EDs consumption was 24%. About 44% of the athletes consumed EDs one to two times per month. Athletes who were training between 5-7 days per week consumed significantly more EDs compared to those who were training 3-4 days per week (81% vs. 15 %, P<0.001). Athletes aged 7-12 years were 2.4 times more likely to consume EDs than athletes aged 13-18 years (P<0.001). Moreover, athletes living with both parents were significantly less likely to consume EDs compared to those living with a single parent (P=0.01). Knowledge score about EDs consumption was significantly higher for non EDs consumers compared to EDs consumers (P<0.001). 
 
 CONCLUSIONS: EDs consumption among young male athletes was moderate. Educational programs are needed to increase the awareness regarding EDs consumption and its potential adverse effects among the young athletes. A regulation policy for EDs consumption should be addressed and consideration of labels with EDs contents and age identification is highly recommended.

Purpose: Energy drinks are becoming increasingly popular among adolescents and young adults. There are concerns raised with the potential negative effects of their ingredients. Caffeine, although generally considered safe, is the most active physiologic ingredient and if consumed in large amounts or combined with other stimulants, can cause significant health problems. We report a case of cardiac arrest in a young male following consumption of energy drinks and alcohol. A 26-year-old male with a history of recent diagnosis of hypertension (HTN) was brought to the hospital after he had cardiac arrest while consuming alcohol with his friend. He had ventricular fibrillation (VF); shocked twice during cardiopulmonary resuscitation; and was intubated. He was not taking prescription medications; however, he was taking “5-hour energy drinks” daily for several days. Family history was insignificant. On examination, he was sedated and on mechanical ventilator. Lab data on admission was significant for white cell count 19,300/cc (4,000-11,000), serum potassium 2.8 meq/dL (3.5-5), bicarbonate 15 mmol/dL (21-32), serum creatinine 1.3 mg/dL (0.6-1.3), alanine transaminase 648 U/L (12-78), aspartate transaminase 783 U/L (15-37), alkaline phosphatase 66 U/L (50-136), and total bilirubin 0.49 mg/dL (0-1). Urine toxicology including cocaine was negative. Serum alcohol was 99 mg/dL (<3). Serum troponin was 0.4 ng/mL (<0.05). Electrocardiogram on admission showed sinus rhythm, poor R-wave progression with normal QTc interval. 2-D Echo showed severe wall motion abnormalities with ejection fraction (EF) of 25-30%, suspicious for ischemic heart disease; however, EF normalized after 3 days, that was highly suggestive of shunned myocardium due to cardiac arrest and DC shock. Cardiac catheterization was unremarkable, which ruled out ischemic heart disease. Patient had an implantable cardiac defibrillator due to a positive electrophysiological study; and was later discharged home in a stable condition. Recent-onset HTN and cardiac arrest with VF in our young patient were most likely contributed by the energy drinks. The major ingredients of energy drinks, i.e. caffeine and taurine, are considered cardiac stimulants and may cause arrhythmias. To date, only two cases of cardiac arrest following energy drink consumption are reported in the medical literature. Liver enzyme profile on admission was consistent with ischemic hepatocellular damage due to cardiac arrest as they trended down to normal during the hospital course. Our case highlights the major health problems of energy drinks and physicians should educate patients against using them in large quantities or combining with other stimulant drugs.

ABSTRACTPosition Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of energy drink (ED) or energy shot (ES) consumption on acute exercise performance, metabolism, and cognition, along with synergistic exercise-related performance outcomes and training adaptations. The following 13 points constitute the consensus of the Society and have been approved by the Research Committee of the Society: Energy drinks (ED) commonly contain caffeine, taurine, ginseng, guarana, carnitine, choline, B vitamins (vitamins B1, B2, B3, B5, B6, B9, and B12), vitamin C, vitamin A (beta carotene), vitamin D, electrolytes (sodium, potassium, magnesium, and calcium), sugars (nutritive and non-nutritive sweeteners), tyrosine, and L-theanine, with prevalence for each ingredient ranging from 1.3 to 100%. Energy drinks can enhance acute aerobic exercise performance, largely influenced by the amount of caffeine (> 200 mg or >3 mg∙kg bodyweight [BW−1]) in the beverage. Although ED and ES contain several nutrients that are purported to affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES based on scientific evidence appear to be caffeine and/or the carbohydrate provision. The ergogenic value of caffeine on mental and physical performance has been well-established, but the potential additive benefits of other nutrients contained in ED and ES remains to be determined. Consuming ED and ES 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance with doses >3 mg∙kg BW−1. Consuming ED and ES containing at least 3 mg∙kg BW−1 caffeine is most likely to benefit maximal lower-body power production. Consuming ED and ES can improve endurance, repeat sprint performance, and sport-specific tasks in the context of team sports. Many ED and ES contain numerous ingredients that either have not been studied or evaluated in combination with other nutrients contained in the ED or ES. For this reason, these products need to be studied to demonstrate efficacy of single- and multi-nutrient formulations for physical and cognitive performance as well as for safety. Limited evidence is available to suggest that consumption of low-calorie ED and ES during training and/or weight loss trials may provide ergogenic benefit and/or promote additional weight control, potentially through enhanced training capacity. However, ingestion of higher calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as part of the total daily energy intake. Individuals should consider the impact of regular coingestion of high glycemic index carbohydrates from ED and ES on metabolic health, blood glucose, and insulin levels. Adolescents (aged 12 through 18) should exercise caution and seek parental guidance when considering the consumption of ED and ES, particularly in excessive amounts (e.g. > 400 mg), as limited evidence is available regarding the safety of these products among this population. Additionally, ED and ES are not recommended for children (aged 2-12), those who are pregnant, trying to become pregnant, or breastfeeding and those who are sensitive to caffeine. Diabetics and individuals with preexisting cardiovascular, metabolic, hepatorenal, and/or neurologic disease who are taking medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should exercise caution and consult with their physician prior to consuming ED. The decision to consume ED or ES should be based upon the beverage’s content of carbohydrate, caffeine, and other nutrients and a thorough understanding of the potential side effects. Indiscriminate use of ED or ES, especially if multiple servings per day are consumed or when consumed with other caffeinated beverages and/or foods, may lead to adverse effects. The purpose of this review is to provide an update to the position stand of the International Society of Sports Nutrition (ISSN) integrating current literature on ED and ES in exercise, sport, and medicine. The effects of consuming these beverages on acute exercise performance, metabolism, markers of clinical health, and cognition are addressed, as well as more chronic effects when evaluating ED/ES use with exercise-related training adaptions.

Background: Little is known about possible links between energy drink use and psychopathology among youth. This study examined cross-sectional and longitudinal associations between energy drink consumption and psychopathology among early adolescents. In addition, associations between psychopathology and coffee consumption were examined to assess whether findings were specific to energy drinks or also applied to another commonly used caffeinated beverage. Methods: One hundred forty-four youth who participated in the Camden Youth Development Study (72 males; mean age 11.9 at wave 1; 65% Hispanic, 30% African American) were assessed using self-report measures of frequency of energy drink and coffee consumption and depression, anxiety, conduct disorder (CD) symptoms, and teacher reports of attention-deficit hyperactivity disorder (ADHD). Youth (92%) were reassessed 16 months later. Results: Concurrently, energy drink and coffee consumption were associated with similar psychopathology symptoms; when the other beverage was adjusted for, energy drinks remained associated with CD and coffee remained associated with panic anxiety. Initial energy drink consumption predicted increasing ADHD and CD over time, though the association with CD dropped to a trend level of significance when coffee was adjusted for. Initial levels of hyperactive ADHD predicted increasing coffee consumption over time; this association remained when energy drinks were controlled. Social anxiety was associated with less increase in energy drink consumption over time, controlling for coffee. Conclusion: Energy drink and coffee consumption among early adolescents are concurrently associated with similar psychopathology symptoms. Longitudinally, the associations between these beverages and psychopathology differ, indicating that these substances have differing implications for development over time.

Adolescent intake of caffeinated energy drinks does not affect adult alcohol consumption in C57BL/6 and BALB/c mice.

It is recommended that youth aged 12-17 years achieve ≥60 min/day of moderate-to-vigorous physical activity (PA) and limit their recreational screen time (ST) to ≤2 h/day. However, whether unhealthy eating behavior is associated with adherence to PA and ST recommendations in youth is largely unknown. This study examined the associations between adherence to PA and ST recommendations with consumption of sugar-sweetened beverages (SSBs) and energy drinks (EDs) in a representative sample of adolescents. Data on 11-19-year-old Ottawa (Canada) students (n=1147) were analyzed using self-reported information on consumption of SSBs and EDs, and time devoted to PA and ST. Multivariable logistic regression analyses were conducted to examine the associations between adherence to PA and ST recommendations and consumption of SSBs and EDs. Adherence to the ST recommendation was inversely associated with consumption of SSBs [odds ratio (OR)=0.42; 95% confidence interval (CI)=0.21-0.86] and EDs (OR=0.54, 95% CI=0.31-0.92) in females only, independent of PA and relevant covariates. However, adherence to the PA recommendation was positively associated with consumption of EDs in females (OR=1.52, 95% CI=1.07-2.17) but not males, while it was not associated with consumption of SSBs in both sexes. Among female adolescents, adherence to the ST recommendation is inversely associated with consumption of SSBs and EDs, while adherence to the PA recommendation is positively associated with consumption of EDs. Future studies should clarify the observed sex differences and determine if decreasing ST can reduce the consumption of SSBs and EDs among adolescents.

Objective To investigate energy drink (ED) consumption and the relationship between ED consumption and sensation seeking among college students and to provide suggestions for management on ED consumption in the students. Methods Using stratified cluster sampling, we conducted a self-administered survey among 2 200 students of grade one to three recruited in two universities in a city with a self-desinged questionnaire and the Sensation Seeking Scale. Results Among the 2 064 students with eligible information, 1 034 (50.1%) and 511 (24.8%) reported having ED and alcohol mixed with energy drink (AmED) consumption during previous one month, with significantly higher ratios of ED and AmED consumption among the boy students than among the girl students (59.2% vs. 40.9%, χ2 = 69.222 and 30.5% vs. 19.0%; χ2 = 36.358; both P Conclusion A half of the college students consume ED and nearly a quarter of college students consume AmED; sensation seeking may be one of the motivations for the students' ED and AmED consumption.

Energy drinks are an increasingly utilized beverage and are gaining popularity in recent years. The U.S. Air Force (USAF) represents a unique population where energy drink consumption may be higher than the general population. To better understand the safety and health impact of energy drinks, this large-scale comprehensive survey was conducted to study energy drink consumption patterns and its associated adverse effects. A survey was conducted across 12 USAF installations to assess self-reported energy drink consumption and adverse effects in the military population. This study was approved by the David Grant USAF Medical Center Institutional Review Board. A total of 9,655 participants participated in the survey. Energy drink consumption was reported in 76.7% of the participants, with 12.0% consuming ≥1 energy drink per day. Male gender, younger age, and enlisted military members are more likely to be high consumers; 58.6% of participants reported having at least once tried a premixed beverage that combines alcohol, caffeine, and other stimulants. Among energy drink users, 60.0% reported experiencing ≥1 adverse effect, and 0.92% reported needing to see a physician or going to the emergency department because of adverse effects from energy drinks. Higher energy drink or premixed combination beverage consumption frequency was associated with increased likelihood of physician or emergency department visits (P ≤ 0.002 for both). Approximately three in four USAF members reported ever consuming an energy drink. Caution should be exercised on the amount of energy drink consumed to limit the risk of serious adverse effects. Future studies should identify populations at greatest risk for adverse effects and alternative sources of energy maintenance to attain optimal mission readiness.