Joanna Logue
Feature Article
HCOM 511
4/7/11
Adolescent Consumption of Caffeinated Energy Drinks:
A Call for Pediatric Guidance
by Joanna Logue
A 28-year-old motocross athlete collapsed after a race. Paramedics at the scene revived
him, but declared cardiac arrest. At the hospital, x-rays of his heart looked normal, and his lungs
and brain were fine, too. He said he felt well until he collapsed. He had no family history of
heart disease. He was in great physical shape and wasn’t using drugs. After six days at the
hospital, he was feeling much better. His doctors prescribed aspirin and sent him home.
So, what went wrong?
During the patient history and physical exam, the young man also revealed that he drank
8 cans of a caffeinated energy drink in the 7 hours leading up to his race. The role of caffeine in
triggering cardiac events is well established. As a stimulant, it can have a number of
pharmacological effects on the heart. But from an energy drink? Cases like this are more
common than you might think.
Health Risks
In 2007, there were 5,500 caffeine overdoses reported in the United States. Of these
cases, 46% occurred in those under age 19. The serious health risks associated with caffeinated
energy drink consumption in adolescents include:

Caffeine intoxication – A clinical condition caused by caffeine overdose. Adolescents
are particularly at risk for overdose because they are less likely to consume caffeine on a
Joanna Logue
Feature Article
HCOM 511
4/7/11
regular basis, and so have a lower tolerance level. Symptoms include anxiety, nausea,
chest pain, insomnia, seizures, and hallucinations.

Synergistic effects of caffeine and taurine – Many caffeinated energy drinks contain
taurine. When combined with caffeine, this stimulant significantly increases heart rate
and blood pressure.

Caffeine dependence and withdrawal – Adolescents are particularly at risk because of
marketing campaigns promoting caffeinated energy drink use among this group.
Caffeine dependence can cause excess caffeine consumption and an inability to quit. An
increase in dependence creates an increased risk for caffeine withdrawal, especially
among adolescents who are more sensitive to the effects of caffeine.

Combined effects of caffeinated energy drinks and alcohol – When mixing energy
drinks with alcohol, users often don’t feel the effects of alcohol intoxication. This can
lead to alcohol poisoning, alcohol-related injury, and increased chance of sexual
violation.
Still, energy drinks are the fastest growing beverage market in the United States. Studies
show that 31% of 12- to 17-year-olds drink them regularly.
So, given the health risks, why the popularity?
Marketed Benefits
Not only are adolescents most at risk for the harmful health effects of caffeinated energy
drinks, but they are also most vulnerable to the associated marketing campaigns. Manufacturers
promote these beverages claiming they provide energy and vitality. The advertised benefits
include increased attention and better athletic and academic performance. Those who drink them
Joanna Logue
Feature Article
HCOM 511
4/7/11
are promised to “have fun and kick butt.” Product media placement is specifically geared toward
adolescents. Risk-taking youth and young males are the main targets. A young motocross racer
could be the poster child for these ad campaigns.
The combination of appealing marketing campaigns and the health risks associated with
caffeinated energy drinks creates a risky situation for adolescents. Furthermore, there is nothing
to prevent them from drinking as much as they want.
Lack of Regulation
The U.S. Food and Drug Administration (FDA) limits the amount of caffeine contained
in soft drinks and over-the-counter drugs. The 1994 Dietary Supplement Health and Education
Act classified substances made out of herbs and natural resources as dietary supplements.
Caffeinated energy drinks are considered dietary supplements. For this reason, the FDA has no
say in what goes into these energy drinks and who can buy them. These decisions are left to the
manufacturers.
Energy drink manufacturers are not required to list the caffeine content on the side of the
bottle. They are also under no obligation to run safety testing or provide warning labels that list
the potential health risks. Some manufacturers put additives in their energy drinks that contain
additional amounts of caffeine. They don’t need to tell anyone about this either. This means that
any 15-year-old can walk into a convenience store, buy as many energy drinks as they want, and
have no idea how much caffeine they are drinking.
If neither the government nor the manufacturers will protect adolescents from the
potentially harmful effects of caffeinated energy drinks, who will?
Call for Anticipatory Guidance
Joanna Logue
Feature Article
HCOM 511
4/7/11
Pediatricians are in a unique position to help guide young patients at critical times during
their development, especially during adolescence, via anticipatory guidance. The American
Academy of Pediatrics states that “preventive pediatrics is the core of quality medical care for
children.” Yet, a study from Pediatrics revealed that anticipatory guidance accounts for only
8.4% of each pediatric office visit. Furthermore, the least amount of anticipatory guidance, 7
seconds, is given to 13- to 17-year-olds.
The anticipatory guidance portion of an office visit is the ideal opportunity for
pediatricians to discuss with adolescents the health risks associated with caffeinated energy
drinks. Adolescents may worry about being judged or getting into trouble, and so may not be
very forthcoming with this information. Pediatricians should find out if they are drinking energy
drinks, and how much. This is especially crucial for adolescents who engage in high-risk
behaviors and for those who have health conditions, such as cardiac defects, that could be made
worse by caffeine. It is also important for physicians to know the symptoms of caffeine
intoxication, withdrawal and dependence.
The 28-year-old motocross racer survived his caffeinated energy drink overdose, without
long-term health effects. But, had his doctor warned him about the potentially harmful effects of
these drinks, he may have avoided the incident all together. Pediatricians need to make it a
priority to discuss the dangers of caffeinated energy drinks during regular office visits with their
patients, especially those who engage in other high-risk behaviors.
______________________________________________________________________________
Joanna Logue
Feature Article
HCOM 511
4/7/11
Audience: Pediatricians
Purpose of Article: The purpose of this article is to convince pediatricians to educate their
adolescent patients about the health risks associated with caffeinated energy drinks. In the past
few years, there have been many documented cases of adolescents overdosing on caffeinated
energy drinks, causing permanent health damage and even death. In the absence of FDA
regulations, it is pediatricians’ responsibility to educate and protect their young patients.
Flesch-Kincaid Grade Level: 11.4
Word Count: 954
Joanna Logue
Feature Article
HCOM 511
4/7/11
References
Berger, A. J., & Alford, K. (2009). Cardiac arrest in a young man following excess consumption
of caffeinated “energy drinks.” The Medical Journal of Australia, 190(1), 41-43.
Reisinger, K. S., & Bires, J. A. (1980). Anticipatory guidance in pediatric practice. Pediatrics,
66(6), 889-892.
Reissig, C. J., Strain, E. C., & Griffiths, R. R. (2009). Caffeinated energy drinks – A growing
problem. Drug and Alcohol Dependence, 99, 1-10. doi:10.1016/j.drugalcdep.2008.08.001
Seifert, S. M., Schaechter, J. L., Hershorin, E. R., & Lipshultz, S. E. (2011). Health effects of
energy drinks on children, adolescents, and young adults. Pediatrics, 127(3), 511-528.
doi:10.1542/peds.2009-3592