Table 2.
Summary of included cases associated with adverse health events in children and adolescents after the consumption of energy drinks.
| Author, Year | Age, Sex | Clinical Presentation | ED Consumption Behavior | Abnormal Results | Diagnosis | Potential Triggers | Preexisting Health Conditions | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Cardiovascular system | |||||||||
| Polat et al., 2013 [17] | 13, M | Acute mid-sternal chest pain | An ED (80 mg caffeine) for the first time the night before admission | Cardiac auscultation: S4 gallop; ECG: 2–3 mm ST-segment elevations in leads II, III, aVF and V3 through V5; dynamic T-wave changes in leads V3–V5 24 h after the onset; TEE: LVEF about 54% with moderate apical hypokinesis; coronary angiography: extensive dissection with a visible tear from the distal part of the LAD artery | SCAD with STEMI | None | None | Acetylsalicylic acid, subcutaneous enoxaparin, sublingual nitroglycerin, enalapril, metoprolol | Complete remission |
| Dufendach et al., 2012 [18] | 13, F | Palpitations, chest pain, shakiness, and dizziness | At least 1 16 oz ED (160 mg caffeine) every other day for 2 weeks prior to presentation | ECG: idiopathic extreme QT-prolongation; genetic testing: LQT1-causative mutation (G179S-KCNQ1) |
Type 1 LQTS | None | Two “possible” fainting episodes | Beta-blockers | Partial remission |
| Di Rocco et al., 2011 [19] | 14, M | Persistent “heart fluttering” | Unknown ED amount the day before presentation | Irregular HR of 130/min with a 1/6 vibratory systolic ejection murmur; ECG: narrow-complex tachycardia with atrial fibrillation and occasional atrial flutter | Arrhythmia | Running race | None | Digoxin | Complete remission |
| Di Rocco et al., 2011 [19] | 16, M | Intoxication, vomiting after minor head trauma | Unknown ED amount mixed with vodka the day prior to admission | Irregular HR of 160/min; ECG: chaotic atrial tachycardia and atrial fibrillation with rapid ventricular response; blood ethanol level: 155 mg/dL | Arrhythmia | Alcohol, baseline stimulant medication (amphetamine, dextroamphetamine, montelukast, loratadine, doxycycline) | ADHD, asthma, allergies | A bolus of normal saline and intravenous fluid support | Complete remission |
| Usman et al., 2012 [20] | 16, M | Palpitations for one week and elevated BP | 80–100 ED cans in two weeks, at least 3 ED cans the day prior to presentation | BP: 150/95 mmHg; regular pulse of 110/min | Arterial hypertension; sinus tachycardia | None | None | None | Complete remission |
| Terlizzi et al., 2008 [21] | 16, F | Three months of orthostatic intolerance and episodes of transient loss of consciousness | 4–5 ED cans per day one week before symptom manifestation | A sharp increase in HR during head up tilt test from 88 to 128 bpm, at the 22nd minute BP and HR decreased and the patient referred dizziness, blurred vision, and malaise | Postural tachycardia syndrome | None | None | None | Complete remission |
| Own institutional experience | 16, F | Collapse, unconsciousness | Multiple ED cans days prior to event | Refractory ventricular fibrillation | Refractory ventricular fibrillation, circulatory failure, consecutive hypoxic brain damage | Lack of sleep, anxiety | History of myocarditis (confirmed by biopsy) | CPR, ECMO | Fatal outcome |
| Wilson et al., 2012 [22] | 17, M | Acute chest pain with radiation to the left arm | 5–7 ED cans (560–800 mg caffeine) the night prior to admission | ECG: Diffuse ST-segment elevations in leads II, III, AVF, V3–V6, and ST-segment depressions in leads V1 and AVR; elevated WBC; reduced potassium and bicarbonate; elevated CK and troponin T; TEE: LVEF at 50% with apical hypokinesis | Acute coronary artery vasospasm | None | Questionable myopericarditis | Acetylsalicylic acid, nitroglycerin, diltiazem | Complete remission |
| Neuropsychological system | |||||||||
| Butragueño Laiseca et al., 2019 [23] | 8, M | Paraesthesia around the oral commissure, clonus and commissure deviation, difficulty speaking and retaining saliva | 1 ED on daily basis, increased intake the week prior to admission | Electroencephalography: bihemispheric epileptiform activity, predominantly during non-REM sleep | Rolandic epilepsy | None | None | Oxcarbazepine | No remission |
| Staikoglou et al., 2022 [24] | 14, M | Dysarthria, headache, mild right-hand weakness, hypesthesia and right optic field deficits | 2 L of ED within 10 h prior to admission | BP: 190/120 mmHg, HR: 116/min, MRI: a typical “string and pearls” sign of the left P2 and P3 posterior cerebral artery segment | Brain ischemia secondary to dissection of posterior cerebral artery | None | None | Anticoagulation therapy | Partial remission |
| Babu et al., 2011 [25] | 15, M | Tonic-clonic seizure, postictal state, repeated vomiting | 2 ED bottles and a cup of coffee within 2 h | Temperature: 38.1 °C; pulse: 120/min, respiratory rate: 40/min; reduced potassium; serum caffeine level: 99 µg/mL; brain MRI: mild ethmoid sinus disease | Tonic-clonic seizure | Additional consumption of a cup of coffee | Seasonal allergies | Intravenous lorazepam, intravenous ondansetron and normal saline | Complete remission |
| Yamada-Takeda et al., 2019 [26] | 16, M | Breakthrough seizure | 9 g ED powder 2 times per day | A significant drop of valproic acid; probable drug-herb interaction (score of drug interaction probability scale: 5) | Breakthrough seizure | None | Generalized epilepsy and seizure-free for 2 years with divalproex extended-release | None | Complete remission |
| Samanta D, 2015 [27] | 16, M | Thunderclap headache, vomiting, left leg numbness and gait difficulty | 4 × 8 oz ED can (320 mg caffeine) several hours before the onset of symptoms | Tachycardia, brisk deep tendon reflexes of the left knee and ankle, positive Babinski sign of the left side; brain MRI: numerous cortical and subcortical foci of abnormally restricted diffusion; MR angiography: diffuse luminal irregularity with intermittent narrowing of distal branches of posterior cerebral artery | Reversible cerebral vasoconstriction syndrome | None | None | Oral analgetic and antiemetic medication, verapamil | Complete remission |
| Quadri et al., 2018 [28] | 17, F | New onset mania for 5 days | 1 or 2 16 oz ED containers (300–600 mg caffeine) per day over 7 days prior to admission | Urine drug screen: positive for cannabis; quantitative THC: 198 ng/mL | Caffeine-induced bipolar disorder | Prior cannabis use | None | Olanzapine | Partial remission |
| Other organ systems | |||||||||
| Apestegui et al., 2011 [29] | 16, M | Jaundiced | 15 cans of ED within 3 days 2 weeks before the first hepatitis episode; 3 cans of ED within 4 h 2 days prior to the second hepatitis episode | Elevated AST, ALT, BIL and GGT; biopsy sample: severe perivenular hepatocellular necrosis, major centrilobular and portal inflammation, minor signs of endotheliitis and cholangitis | Cholestatic hepatitis | None | Liver transplantation due to biliary tumor, retransplantation due to biliary tract lesions | Unchanged low-dose tacrolimus monotherapy | Partial remission |
| Robin et al., 2017 [30] | 17, M | Elevated ALT | Chronic consumption of 6 × 500 mL ED cans per day | Elevated ALT up to 274 U/L; ultrasound: moderate liver steatosis; liver biopsy: moderate steatosis and mild steatohepatitis | NASH | None | Fatigue | Change of diet and lifestyle | Partial remission |
| Schöffl et al., 2011 [31] | 17, M | Vomiting, dizziness, hyperventilating and capsular pain over both kidneys | 3 L ED (780 mg caffeine and 4600 mg taurine) mixed with 1 L vodka (380 g alcohol) over the course of an evening | Tachycardiac with an HR of 110/min, transient hypertension, serum creatinine: 6.9 mg/dL, urine sediment revealed acute tubular necrosis | Acute renal failure | Alcohol, 2 × 100 m running races | None | Hemodialysis, enalapril | Complete remission |
| Yazdi et al., 2008 [32] | 11, M | Asymptomatic lesions at both upper and lower extremities for 5 months | 1 ED daily | Physical examination: multiple ochre macules and patches with central petechiae localized on limbs and the lower abdomen; biopsy: epidermal acanthosis with intra-epidermal collection of lymphocytes; iron-stain detection of hemosiderin: lymphocytic infiltrate of the upper dermis containing hemosiderin deposits and extravasal erythrocytes adjacent to dermal blood vessels; PCR of T-cell receptor-γ: clonal rearrangement | Lichen aureus | None | None | ED abstinence | Complete remission |
ADHD: attention deficit hyperactivity disorder, ALT: alanine aminotransferase, AST: aspartate aminotransferase, BIL: bilirubin, BP: blood pressure, CK: creatine kinase, CPR: cardiopulmonary resuscitation, ECG: electrocardiogram, ECMO: extracorporeal membrane oxygenation, ED: energy drink, F: female, GGT: gamma-glutamyltransferase, HR: heart rate, LAD: left anterior descending artery, LQTS: Long QT syndrome, LQT1: Long QT syndrome type 1, LVEF: left ventricular ejection fraction, M: male, MRI: magnetic resonance imaging, NASH: non-alcoholic steatohepatitis, PCR: polymerase chain reaction, REM: rapid eye movement, SCAD: spontaneous coronary artery dissection, STEMI: ST-segment elevation myocardial infarction, THC: tetrahydrocannabinol, TTE: transthoracic echocardiography, WBC: white blood count.