“Energy drinks” are beverages that contain caffeine, taurine, ginseng, guarana, vitamins, herbal supplements, and sugar
]. They are usually merchandised to improve energy, performance, and concentration spans. The market for energy drinks is continually growing and the annual worldwide energy drink consumption is increasing
According to self report surveys, energy drinks are consumed by 30 to 50% adolescents and young adults. They are available in around 140 countries in the world including Pakistan
]. Globally, young adults especially students and athletes are primary targets of campaigns carried out by energy drink companies. They are frequently consumed by athletes prior to competitions with a view to improve their performance
]. They are also consumed by a large number of students especially while studying for Exams to cope with stress. In a survey of 496 college students conducted in Central Atlantic region of Unites States, 51% reported consuming at least one energy drink in the last month. It was found that 67% used it for insufficient sleep, 65% used it for insufficient energy, and 54% used it with alcohol in parties. Out of all, 22% reported having headaches after it and 19% had palpitations
]. In our case, he was also a student who had consumed it for remaining awake whole night studying for his Exams.
Caffeine is the main active ingredient in energy drinks and its concentration is almost 3 times that in cola drinks but it can go up to 5 times, because of added products like guarana, cocoa and kola nut
]. Guarana is a plant that contains caffeine, theobromine and theophylline which are chronotropes and ionotropes respectively
]. Doses of caffeine found in energy drinks can range from 80 to 300 mg in a 240 ml-ounce serving. However, some brands are sold in 500 or 700 ml sizes, which increases the chances of caffeine consumption
]. The FDA presently regulates the amount of caffeine in soft drinks to a specific maximal dosage and also requires warning instructions to be written on over the counter stimulant medications, but energy drinks are not subjected to the same regulations though they contain much higher caffeine content
]. The product “Sting” which our case consumed is the local version and its 500 ml (2 serving) bottle does have a label of ingredients including caffeine. It also has a small precaution for children and pregnant women, but the message is not as strong as the health warning on smoking packs. However, the 250 ml (single serving) bottle does not have any ingredients label and health warning, at all.
Caffeine intoxication is a documented clinical syndrome included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the World Health Organization’s International Classification of Diseases(ICD-10)
]. Excessive caffeine consumption has been found to have injurious health consequences. A pilot study conducted on 18–45 years old healthy, normotensive, non smoking subjects found that single day energy drink supplementation increased mean 24-hour and daytime blood pressure compared to caffeine control
]. A similar study conducted on 15 individuals of 18–40 years age group showed that consumption of 2 cans of energy drinks daily for one week increased heart rate by 5–7 beats per minute and systolic blood pressure increased by 10 mm Hg
]. The above 2 studies show that excessive energy drink consumption can lead to hypertension as seen in our case.
Cardiac arrest was reported in a 28 year old athelete who had consumed excessive amount of energy drinks containing caffeine
]. 3 cases of new onset seizures were reported in adults associated with tachycardia and systolic hypertension which did not re occur after the patients remained abstinent from energy drinks for a few months
]. Even death has also been reported in four documented cases due to excessive energy drinks consumption
]. A double blind study conducted on 13 endurance trained participants showed that original RED BULL drink containing taurine increases cardiac contractility
]. Since caffeine is also a diuretic and these energy drinks are usually consumed by children and adolescence before sports event, the combined effect of sweating and diuresis can lead to severe dehydration
]. In Pakistan also, numerous children and adolescent athletes consume them before and after sport activities to boost their energy. Majority of them are totally unaware of their ingredients and their harmful effects as there is no clear labeling of health warning over them. Our case was also not aware that “Sting” had caffeine and about its harmful health effects.
Producers of energy drinks usually target young adults who are easily lured to consume energy drinks after watching numerous appealing marketing advertisements on television, in newspapers and magazines
]. Regulation of energy drinks, including content labeling and health warnings has differed across countries. USA has the most lax regulatory requirements, and is also the largest market for these products. The absence of regulations has resulted in aggressive marketing of energy drinks
]. And there is absolutely no check in Pakistan on import, sale and content regulation of these energy drinks.