Energy Drinks: The New Eye-Opener For Adolescents
Kavita M. Babu, MD,
⁎
Richard James Church, MD,
⁎
William Lewander, MD†
The availability of caffeine-containing energy beverages, combined with aggressive
marketing and urban legend, has promoted their widespread use, particularly among
adolescents. The caffeine content of these products is presently unregulated. Rapid growth
in the consumption of these supplements has resulted in increasing reports of caffeine
poisoning. This article provides a review of caffeine’s pharmacokinetics and describes the
clinical manifestations and management of caffeine toxicity. Suggestions for future
research are also offered.
Clin Ped Emerg Med 9:35-42 C 2008 Published by Elsevier Inc.
KEYWORDS energy drink, adolescents, caffeine, guarana, taurine, carnitine, withdrawal
B
y promising immediate energy and decreased fatigue,
energy drink brands have created a $3.5 billion yearly
industry [1]. Aggressive marketing campaigns featuring
celebrities and athletes target adolescents and young
adults. A culture of blogs, urban legends, and “under-
ground” chic has further increased their appeal. In 2006,
more than 30% of adolescents reported using energy
drinks, an increase of more than 3 million teens in 3 years
[2]. The wide availability of the beverages, from grocery
stores, convenience stores and school bookstores makes
them readily accessible for purchase by adolescents, even
though the products often retail for more than twice the
price of “traditional” soft drinks. Although the media has
clearly identified the trend toward increasing adolescent
energy drink use, little medical literature describes this
phenomenon. The goals of this article include identifying
major ingredients of energy drinks, as well as a discussion
of the pharmacology and toxicology of caffeine.
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 brewed
coffee (56-100 mg/100 mL), instant coffee and tea (20-
73 mg/100 mL), and colas (9-19 mg/100 mL) [5]. Smaller
amounts can be found in chocolate (5-20 mg/100 g) and
cocoa (7 mg/5 oz cup) [6]. In addition, over-the-counter
medications such as NoDoz and Midol contain between
100 and 200 mg of caffeine per tablet [6].
Average caffeine consumption in the United States and
Canada ranges from approximately 1 mg/kg per day in
children to 3 mg/kg per day in adults [7,8]. Intake has been
known to be much higher in certain European countries
such as Denmark, where consumption reaches 7 mg/kg per
day [3]. Canadian recommendations for daily caffeine are
no more than 85 mg for children aged 10 to 12 years, no
more than 300 mg in women of childbearing age, and
no more than 400 to 450 mg in the remaining adult
population [9].
The Food and Drug Administration has limited the
caffeine content of sodas to 65 mg per 12 oz (18 mg/
100 mL); however, energy drinks are not currently subject
⁎
Division of Medical Toxicology, Department of Emergency Medicine,
University of Massachusetts, Worcester, MA.
†
Division of Pediatric Emergency Medicine, Department of Emergency
Medicine, Brown Medical School/Hasbro Children's Hospital,
Providence, RI 01655.
Reprint requests and correspondence: Kavita M. Babu, MD, Division of
Medical Toxicology, Department of Emergency Medicine, University
of Massachusetts, Worcester, MA. (E-mail: kavita_babu@yahoo.com)
1522-8401/$ - see front matter C 2008 Published by Elsevier Inc.
35
doi:10.1016/j.cpem.2007.12.002