Energy Drinks and the ER - perspective

Energy drinks are in the news again, and this time the story is the reported increase in emergency room visits attributed to energy drinks. Consider this brilliant article from Food Navigator USA:
DAWN report on energy drinks and ER visits Correlation is not causation but something is going on here

A few very important points:

* 42% of the visits attributed to energy drinks also involved alcohol or other drugs
Mixing alcohol and energy drinks is indeed very dangerous, as people feel more alert but still have impaired reflexes: "The mix of behavioral impairment with reduced fatigue and enhanced stimulation may lead AmED (alcohol mixed with energy drinks) consumers to erroneously perceive themselves as better able to function than is actually the case." Published Study: Effects of energy drinks mixed with alcohol on information processing, motor coordination and subjective reports of intoxication.


* The Drug Abuse Warning Network (DAWN) report doesn't include any data on how much caffeine was consumed prior to the emergency room visit, or over what period of time it was consumed
"...for the healthy adult population, moderate daily caffeine intake at a dose level up to 400 mg day(-1) (equivalent to 6 mg kg(-1) body weight day(-1) in a 65-kg person) is not associated with adverse effects..."Published Study: Effects of caffeine on human health

* DAWN project leader Albert Woodward poses a crucial question: if it's the high caffeine from the energy drink causing the trips to the ER, why don't people who've consumed high caffeine intakes from coffee come in to the ER?
This is the million dollar question, because we don't know if the people admitted to the ER have had multiple energy drinks or energy shots in a short amount of time or if they were using the product as directed. How long does it take to drink one energy shot? How long does it take to make/brew/buy coffee? 

Are those admitted to the ER an indication that energy drinks (including energy shots) have some inherent danger that isn't apparent from the Generally Recognized As Safe ingredients on the label, or should we suspect these people are not using the product as intended - like a small child that likes the taste of vitamin gummies so much they eat half the jar? Would limiting energy drinks to single-serving containers alleviate the problem? (Perhaps, but go ask a New Yorker how much they like it when you try to limit their sodas to single-serving size)

No one knows whether energy drinks are inherently dangerous when used as directed, because the people making the news aren't always following the instructions and warnings on the label.  We should be cautious of using and abusing these products. We should keep monitoring the situation and collect as much data as possible about all the circumstances involved.

Remember these words from the "Father of Toxicology", Paracelsus:
All things are poison, and nothing is without poison; only the dose permits something not to be poisonous.

Or, as the band Circa Survive put it, "The Difference Between Medicine And Poison Is In The Dose."





Other Resources:

Published Review (FULL TEXT - FREE): Caffeine (1, 3, 7-trimethylxanthine) in Foods: A Comprehensive Review on Consumption, Functionality, Safety, and Regulatory Matters 

Letter from FDA to Senator Durbin, addressing his concerns about energy drinks: (available as a pdf file through a link within this article from Food Products Insider)
FDA Tells Durbin It's Investigating Safety of Energy Drinks