APPENDIX.

Representative Sample of Adverse Events Reported in Association With Nonalcoholic Energy Drink Consumption

Source of Information	No. and of Age Patients	Previous Health Conditions	Symptoms	Reported Association With Energy Drink	Ref No.
Journal articles/case reports	One 25-y-old woman	Mitral valve prolapse	Unknown	Drank a bottle of Race 2005 Energy Blast with guarana and ginseng on the day that she had a cardiac arrest; the autopsy and toxicological screen results were negative except for a caffeine concentration of 19 mg/L in aortic blood	29
	One 25-y-old man	None reported	Generalized seizures on 2 occasions over 4 mo; the seizures did not reoccur within 6 mo after abstaining from energy drinks	Reportedly drank energy drinks on an empty stomach; he reported consuming two 24-oz energy drinks 30–60 min before the seizure	27
	One 31-y-old man	None reported	Rhabdomyolysis and acute kidney failure with tubular necrosis	Active football referee drank 3 cans of Red Bull before a 3000-m competition; the authors stated that the taurine could have caused the rhabdomyolysis from hyperosmolarity because the distance was relatively short compared with his normal training	25 and 38
	One 43-y-old man	Paranoid-type schizophrenia and alcohol dependence in full, sustained remission	6-wk history of worsening paranoia, delusions, and agitation resulting in hospitalization	Started drinking energy drinks 2 wk before becoming symptomatic; consumption increased to 8–10 cans per d; the cessation of caffeine reportedly improved symptoms	114
	One 47-y-old man	None reported	Delusions and paranoia; the psychosis resolved within 7 wk after reducing caffeine consumption	High caffeine intake	13
	2 patients	Migraine headaches	Seizures	In 1 case, the energy drink was consumed on an empty stomach; in the other case, caffeine tablets were also consumed with the energy drink	26
	2 depressed patients and 1 patient with no psychiatric illness	Started on ginseng for several months	Unknown	Mania, which resolved after stopping taking ginseng	8
	One young professional volleyball player	None reported	Developed orthostatic intolerance, postural tachycardia, and syncope, which resolved after energy drink consumption was stopped	4–5 cans of Red Bull per d	75
Newspaper articles	4 middle school students	None reported	All transported to the hospital with tachycardia, hypertension, paresthesias, diaphoresis, jitters/anxiety; hypokalemia and hyperglycemia were diagnosed in the emergency department	All 4 shared 1 can of Redline energy drink	16
	7 high school students	None reported	Shortness of breath, heart palpitations, nausea; 2 students were treated in a hospital	SPIKE Shooter	34
	One teenaged boy	None reported	Severe stomach pain for ∼2 mo; endoscopic findings included severe inflammation, bleeding, and ulcerations in the duodenum	Several Redline energy drinks (250 mg of caffeine per 8-oz serving) per d	32
Marin Institute	One 14-y-old girl	Diabetes	2 d after drinking 1 can of SPIKE Shooter, she was hospitalized for a seizure	SPIKE Shooter	43
	One 18-y-old girl	None reported	Died after sharing 4 cans of Red Bull with friends and then playing basketball	Red Bull	43
Online news sources	One 14-y-old girl	Diabetes	Seizure	Reportedly drank 1 can of an energy drink before the seizure	25 and 38
	One 17-y-old girl	None reported	Collapsed at the finish of a track race and was rushed to the emergency department after reporting chest pain and fatigue	Regularly skipped breakfast and drank 2 or 3 cans of Red Bull	1
	One 28-y-old man	None reported	The man reportedly drank energy drinks and then engaged in the strenuous physical activity of motocross; he subsequently died from a cardiac arrest, presumably from coronary vasospasm caused by the energy drinks	Unknown energy drink; unspecified but large numbers of energy drinks that contained high levels of caffeine and taurine were consumed	28
	One 47-y-old man	None reported	“I thought I was having a heart attack. I thought I was going to die.” The next day he reported feeling sore and exhausted from the experience	Two 8-oz cans of VPX Redline	119