Energy drinks: health risks and toxicity

Naren Gunja and Jared A Brown
Med J Aust 2012; 196 (1): 46-49. || doi: 10.5694/mja11.10838


Objectives: To describe the epidemiology and toxicity of caffeinated energy drink exposures in Australia.

Design, setting and subjects: Retrospective observational study analysing data from calls regarding energy drink exposures recorded in the database of an Australian poisons information centre over 7 years to 2010.

Main outcome measures: Type of exposure; co-ingestants; symptoms reported; and reported hospitalisations.

Results: Callers reported 297 exposures to energy drinks, which showed an increasing annual trend from 12 in 2004 to 65 in 2010. Median age for the 217 subjects with recreational exposure was 17 years (interquartile ratio [IQR], 15–21; range, 11–60) and 57% were male. One hundred recreational users co-ingested other substances, predominantly alcohol (50) or other caffeinated products (44). The number of energy drinks consumed in one session varied greatly (median, 5 units; IQR, 3–8; range, 1–80). Most subjects who reported recreational use reported experiencing symptoms (87%). The most common symptoms were palpitations, agitation, tremor and gastrointestinal upset. Twenty-one subjects had signs of serious cardiac or neurological toxicity, including hallucinations, seizures, arrhythmias or cardiac ischaemia. At least 128 subjects (57 with no co-ingestants) required hospitalisation.

Conclusions: Reports of caffeine toxicity from energy drink consumption are increasing, particularly among adolescents, warranting review and regulation of the labelling and sale of these drinks. Educating adolescents and increasing the community’s awareness of the hazards from energy drinks is of paramount importance.

  • Naren Gunja1,2
  • Jared A Brown1

  • 1 NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, NSW.
  • 2 Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, NSW.


Competing interests:

No relevant disclosures.

  • 1. AC Nielsen. Nielsen convenience report, 2008. (accessed Mar 2011).
  • 2. Higgins JP, Tuttle TD, Higgins CL. Energy beverages: content and safety. Mayo Clin Proc 2010; 85: 1033-1041.
  • 3. Malinauskas BM, Aeby VG, Overton RF, et al. A survey of energy drink consumption patterns among college students. Nutr J 2007; 6: 35.
  • 4. Arria AM, Caldeira KM, Kasperski SJ, et al. Energy drink consumption and increased risk for alcohol dependence. Alcohol Clin Exp Res 2011; 35: 365-375.
  • 5. Attila S, Cakir B. Energy-drink consumption in college students and associated factors. Nutrition 2011; 27: 316-322.
  • 6. Riddell L, Keast RS. Is caffeine in soft drinks really necessary [letter]? Med J Aust 2007; 187: 655. <MJA full text>
  • 7. Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks — a growing problem. Drug Alcohol Depend 2009; 99: 1-10.
  • 8. Seifert SM, Schaechter JL, Hershorin ER, et al. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics 2011; 127: 511-528.
  • 9. AC Nielsen. Nielsen convenience and impulse report, 2010. ReportJune2010LR.pdf (accessed Mar 2011).
  • 10. Red Bull Australia. Red bull products. (accessed Feb 2011).
  • 11. Pennay A, Lubman DI, Miller P. Combining energy drinks and alcohol — a recipe for trouble? Aust Fam Physician 2011; 40: 104-107.
  • 12. Food Standards Australia New Zealand. Australia New Zealand Food Standards Code — Standard 2.6.4 (2009): formulated caffeinated beverages. (accessed Nov 2011).
  • 13. Duchan E, Patel ND, Feucht C. Energy drinks: a review of use and safety for athletes. Phys Sportsmed 2010; 38: 171-179.
  • 14. Hu Z, Yang X, Ho PC, et al. Herb-drug interactions: a literature review. Drugs 2005; 65: 1239-1282.
  • 15. McGee MB. Caffeine poisoning in a 19-year-old female. J Forensic Sci 1980; 25: 29-32.
  • 16. Benowitz NL, Osterloh J, Goldschlager N, et al. Massive catecholamine release from caffeine poisoning. JAMA 1982; 248: 1097-1098.
  • 17. Shum S, Seale C, Hathaway D, et al. Acute caffeine ingestion fatalities: management issues. Vet Hum Toxicol 1997; 39: 228-230.
  • 18. Di Rocco JR, During A, Morelli PJ, et al. Atrial fibrillation in healthy adolescents after highly caffeinated beverage consumption: two case reports. J Med Case Reports 2011; 5: 18.
  • 19. Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac arrhythmia: an unrecognised danger of healthfood products. Med J Aust 2001; 174: 520-521. <MJA full text>
  • 20. Menkes DB. Transient psychotic relapse temporally related to ingestion of an “energy drink” [letter]. Med J Aust 2011; 194: 206. <MJA full text>
  • 21. Berger AJ, Alford K. Cardiac arrest in a young man following excess consumption of caffeinated “energy drinks”. Med J Aust 2009; 190: 41-43. <MJA full text>
  • 22. Worthley MI, Prabhu A, De Sciscio P, et al. Detrimental effects of energy drink consumption on platelet and endothelial function. Am J Med 2010; 123: 184-187.
  • 23. O’Brien MC, McCoy TP, Rhodes SD, et al. Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med 2008; 15: 453-460.
  • 24. Kaminer Y. Problematic use of energy drinks by adolescents. Child Adolesc Psychiatr Clin N Am 2010; 19: 643-650.
  • 25. Waring WS, Laing WJ, Good AM, et al. Acute caffeine ingestion: clinical features in patients attending the emergency department and Scottish poison centre enquiries between 2000 and 2008. Scott Med J 2009; 54: 3-6.
  • 26. Crouch BI, Caravati EM, Booth J. Trends in child and teen nonprescription drug abuse reported to a regional poison control center. Am J Health Syst Pharm 2004; 61: 1252-1257.
  • 27. McCarthy DM, Mycyk MB, DesLauriers CA. Hospitalization for caffeine abuse is associated with abuse of other pharmaceutical products. Am J Emerg Med 2008; 26: 799-802.
  • 28. O’Dea J, Rawstorne P. Consumption of dietary supplements and energy drinks by school children. Med J Aust 2000; 173: 389.
  • 29. The Australia and New Zealand Food Regulation Ministerial Council. Food Ministers briefed on progress of historic Food Labelling Review. (accessed Jun 2011).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.