![]() There was no serologic evidence of acute hepatis A, B, C or E and tests for Epstein Barr virus and cytomegalovirus infection were negative. Laboratory tests showed marked elevations in ALT and AST (Table) but normal levels of bilirubin, alkaline phosphatase and GGT. She denied alcohol or drug abuse and was not taking other medications. The following day she developed jaundice and was admitted to the hospital. On examination in the emergency room, she had epigastric tenderness but no other findings and was sent home. Acute liver injury attributed to use of energy drinks.( 1)Ī 22 year old woman developed low grade fever, abdominal pain, nausea and vomiting and was found to have abnormal liver tests after having consumed 10 cans of energy drinks daily for 2 weeks. Likelihood score: C (probable rare cause of clinically apparent liver injury when used in high amounts).Ĭase 1. Thus, caffeine is unlikely to cause liver injury, but the various high caffeine energy drinks which are widely used may possibly cause liver injury when used to excess. The reports of caffeine overdose including cases with autopsies, hepatic injury has been absent or not mentioned. Furthermore, it remains unclear whether the hepatic effects of the energy drinks were caused by caffeine per se or to other components included in their formulation, such as vitamins, herbs or other botanical products. In other cases, other diagnoses were not completely ruled out (Case 2). In several instances, the hepatic injury resembled acute hepatic necrosis or ischemic hepatitis (Case 1) that may have been due to a drug overdose or cardiac arrest. These reports were often incompletely documented and not completely convincing. In addition, there have been several single case reports of liver injury linked to use of caffeine-rich energy drinks. Neverless, when taken in excessive amounts they can lead to caffeine toxicity with tremors, confusion, mania, stupor and coma and cardiac arrhythmias and cardiorespiratory failure. In high doses, generally in excess of 1000 mg daily, caffeine can have severe toxicity, marked by confusion, excessive anxiety, mania, hallucinations, seizures, rhabdomyolysis, cardiorespiratory arrest and death.Ĭaffeine Content of Selected Soft Drinks and Energy Drinks Available in the United StatesĬaffeine containing energy drinks are widely used and generally well tolerated. Adverse side effects of caffeine are generally dose related and can include nervousness, irritability, insomnia, headaches, rapid heartbeat, tremor, and gastrointestinal discomfort. Caffeine in typical amounts is well tolerated and not associated with significant side effects or long term adverse outcomes. Caffeine has been shown to have psychoactive properties and to increase alertness and wakefulness and improve physical and athletic performance, although to a minor degree and with considerable inter-individual variability. The average caffeine content in selected energy drinks and soft drinks is shown in the table below. Caffeine is also present in regular soft drinks but generally in amounts similar to tea (2 to 5 mg/oz and 24 to 60 mg per 12 oz can), although soft drink brands with extra caffeine have also become popular (Pepsi Max, Jolt Cola, Mountain Dew Energy). The caffeine content of these products varies from 5 to 40 mg per ounce, and a single serving (8 to 24 ounces 235-710 mL) may contain up to 300 mg of caffeine. Popular brands include Red Bull, Monster, Rockstar, NOS Energy, Xyience, Bang, Celsius, Zevia, Full Throttle and Kick Start. The commercial products vary greatly in concentration of caffeine as well as in other characteristics, such as carbonation, flavoring, sugar and sweeteners, vitamins, minerals, amino acids and botanical ingredients. ![]() Energy drinks were first marketed in the late 1990s and have subsequently become popular and widely available. ![]() Energy drinks are defined as beverages with high concentrations of caffeine that are purported to boost energy, physical and athletic performance and mental alertness. ![]()
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