Energy drink exposure common in young children, linked to serious adverse CV events

CHICAGO — More than 50% of reports of energy drink exposure to US poison control centers from 2010 to 2013 involved children aged younger than 6 years, with serious adverse cardiac and neurological outcomes occurring in many cases and across all age groups, according to data presented at the American Heart Association Scientific Sessions.

Steven Lipshultz, MD, and colleagues analyzed records from the American Association of Poison Control Centers’ National Poison Data System from October 2010 to September 2013 which contained information calls about energy exposures from the public and health care providers to 55 US poison control centers. Exposures were defined as actual or suspected contact with any substance that has been ingested, inhaled, absorbed, applied to or injected into the body, regardless of toxicity or clinical manifestation, according to a press release.

Steven Lipshultz

During the study period, there were 10,610 reports of energy drink exposure. Of those, 4,780 involved exposure to a nonalcoholic, caffeinated energy drink. Half of the cases of exposure to nonalcoholic, caffeinated energy drinks occurred in children aged younger than 6 years. Most exposures were unintentional (75%), while intentional exposures were most common among patients aged 13 to 19 years.

The researchers also analyzed the clinical effects of energy drink exposure. Moderate effects were defined as pronounced, prolonged or systemic symptoms that required treatment, but were not life-threatening. Major effects were defined as life-threatening or leading to marked residual disability.

Moderate or major clinical effects related to energy drink exposure were more likely to occur with increasing age. Sixty-four percent of reported cases with moderate or major clinical effects occurred in patients aged older than 20 years compared with just 2% in patients aged younger than 6 years (P<.001). Outcome severity was also greater in individuals exposed to products containing caffeine from multiple sources, compared with pharmaceutical caffeine alone (15.6% vs. 12.7%; P=.051).

Reports of exposure to ethanol-containing energy drinks were associated with increased severity of moderate or major clinical outcomes compared with energy drinks that did not contain ethanol (42% vs. 19%; P<.001). The researchers noted that exposure to ethanol-containing energy drinks declined after an FDA ban on prepackaged energy drinks containing alcohol went into effect in 2010.

Across all age groups with major clinical outcomes, CV effects including arrhythmia disorders and conduction abnormalities were reported in 57% of cases and neurological effects including seizure in 54% of cases. The effects most frequently observed with exposure to non–ethanol-containing energy drinks were neurologic (20%), gastrointestinal (15%) and cardiovascular (12%).

Lipshultz recommended increased awareness and counseling on the risks of energy drinks for adults, teenagers and children with underlying cardiac disorders; those susceptible to sudden death; patients with HF, cardiomyopathy, CAD and atherosclerosis; and those with a history of MI. The increased prevalence of reports involving children aged younger than 6 years is of particular concern, as it suggests greater susceptibility to adverse effects in a younger population, he told Cardiology Today.

In addition, the researchers found no significant decrease in calls to US poison controls during the study period. Short-term improvements after increased media awareness, educational campaigns and legal restrictions were observed, but the effects were not sustainable over time.

Compared with the overall consumption of energy drinks each year, the number of individuals who experience adverse effects is “relatively small,” Lipshultz said. However, “we don’t know who is going to be susceptible [to these effects]. So, with really no therapeutic benefit [from energy drink consumption], my conclusion as a doctor is that I wouldn’t recommend them to anyone,” he said.

Lipshultz noted that the findings of this analysis may underestimate the effects of energy drink exposure, as people who become ill from consumption may not contact poison control centers and ED visits related to consumption were not included in the study. – by Adam Taliercio

For more information:

Seifert SA. Abstract #14841. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.

Disclosure: Lipshultz reports no relevant financial disclosures.