Energy drink exposures and trends in children and young adults reported to the National Poison Data System

Background: Energy drinks (EDs) may contain caffeine, amino acids, vitamins, and other ingredients that have been associated with serious adverse effects, primarily in children and young adults. Objectives: We sought to understand ED exposures, including demographic trends, clinical effects, and outcomes in the US Poison Centers' National Poison Data System (NPDS), and compared similar reports of caffeinated beverages. Methods: We analyzed all NPDS closed human exposures to single-use EDs reported to NPDS between October 1, 2010, and September 30, 2013. Results: NPDS recorded 10,588 cases of ED exposure. Active ingredients were identified in 5139 (49 %) cases. Of the 4803 (93 %) exposures to alcohol-free EDs, 51 % were in children 5 years old or younger, 10 % were in children 6 to 12 years old, 16 % were in adolescents 13 to 19 years old, and 23 % were adults at least 20 years old. Unintentional exposures were highest in children 5 years old or younger (75 %). Intentional exposures were highest in adolescents (45 %). Moderate or major adverse outcomes from EDs containing multiple caffeine ingredients were more common than single ingredient caffeine products (23 % vs. 15 %; P < 0.001). Exposures associated with ethanol EDs had worse outcomes than those without (42 % vs. 19 %, respectively; P < 0.001). The most common clinical effects associated with ED exposures were neurologic (N = 1042, 22 %), gastrointestinal (N = 792, 17 %), and cardiovascular (N = 567, 12 %); 14 cases were life-threatening, and 1 adolescent girl with vascular Ehlers Danlos syndrome died. Recent follow up from January 1, 2020, to December 31, 2021, shows consistent trends in use and a clear difference between EDs and caffeinated beverage case numbers and medical outcomes. The number of cases was similar in each year except for a notable increase mid-2020, believed to be related to the pandemic, with our query returning 4367 reported ED cases between 2020 and 2021. Conclusion: A substantial proportion of ED calls to poison centers involve children, some of whom experience severe neurologic and cardiac toxicity, among other symptoms. ED exposure calls are more common and have more medical severity than exposures to caffeine or coffee beans alone. The number and severity of adverse ED events warrant efforts to educate the public about the risks, especially in children.