FROM THE AHA SCIENTIFIC SESSIONS

Children under 6 years old are among those at the highest risk for poison control calls related to energy drinks, yet those most likely to experience moderate or major clinical effects from energy drinks are adults and often involve mixing with alcohol, according to a recent study.

Approximately 40% of all calls involving single-product energy drinks (not mixed with alcohol) were unintentional exposures by children under 6 years old, according to researchers led by Dr. Steven E. Lipshultz , chair of the department of pediatrics at Wayne State University in Detroit.

“We recommend improved labeling of caffeine content and continued efforts to decrease pediatric exposures to these products,” the researchers concluded in a presentation at the American Heart Association scientific sessions Nov. 16.

Emergency department visits involving caffeinated energy drinks in children under 12 years of age increased “exponentially” between 2005 and 2011, from 840 cases of adverse reactions in 2005 to 14,042 cases in 2011, according to Drug Abuse Warning Network background information in the presentation.

For their study, the researchers analyzed all cases of energy drink exposure reported to the U.S. National Poison Data System during October 2010 and September 2013. These include calls to 55 poison control centers in the United States.

Among the total 10,610 cases reported, 5,156 (49%) were single-product exposures with ingredients that could be identified, thereby excluding exposures related to alcoholic mixes or other combinations.

Mixtures of energy drinks and alcohol produced the most serious problems, with moderate to major effects occurring in 42% of cases involving alcohol and 19% of cases without alcohol (P < .001). Exposures involving alcohol have fallen sharply, though, since a 2010 Food and Drug Administration ban on prepackaged energy drinks containing alcohol, the researchers reported.

Both pharmaceutical-grade caffeine and caffeine from other sources may be in energy drinks, according to a statement from the American Heart Association. In this study, 23% of cases related to drinks with both pharmaceutical and additional caffeine resulted in moderate or major outcomes, compared with 15% of cases involving drinks with only pharmaceutical-grade caffeine (P < .001).

Children were least likely to experience major problems, with only 4% of cases with major or moderate effects involving children under age 12 years. Meanwhile, 64% of cases resulting in moderate or major clinical effects involved adults aged 20 years and older.

The most commonly affected organ system for non–alcohol-related energy drink exposures was neurologic, composing 20% of all clinical effects reported. These symptoms included agitation/irritability, dizziness, lethargy, headache, seizures, and tremors.

In addition, 15% of the cases involved gastrointestinal effects, such as abdominal pain, diarrhea, nausea, and vomiting, and 12% involved cardiovascular effects, which included chest pain, hypertension, arrhythmia, and tachycardia, among others.

Among the cases involving major clinical effects, 57% were cardiovascular, 54% were neurologic, and 14% were gastrointestinal. Some patients had multiple effects in more than one organ system.

Children younger than age 6 years represented the highest proportion of unintentional exposures, 75% of the total, while 10% of unintentional exposures occurred to children aged 6-12 years. Among intentional exposures, on the other hand, 45% included teenagers aged 13-19 years, and 41% included people aged 20 years and older.

These findings, based on poison control center reports, underestimate the problem, the researchers noted, because “many people who become ill from energy drinks don’t call the hotlines and emergency room visits are not included.” Those that are reported may, however, be biased in favor of greater toxicity, they said.

Information on funding and disclosures was unavailable.

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