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Interviewer: Energy drinks, accidental overdose, and who is most at risk. That's next on The Scope.

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Interviewer: We're talking with Dr. Barbara Crouch, the Medical Director of the Utah Poison Control Center today. She also happens to be an expert on energy drinks. Tell us a little bit about energy drinks, Dr. Crouch.

Dr. Barbara Crouch: Well energy drinks have just exploded on the market in the last decade, and they are very popular, especially among teens. And energy drinks contain a lot of caffeine, and caffeine in a variety of sources. So I think one of the issues with energy drinks is that we tend to add a lot more caffeine into our diet every day in addition to maybe other sources of caffeine. So it's important to be aware of the fact that energy drinks contain a lot of caffeine, so that as we balance the rest of our diet we can take that into consideration and avoid any adverse consequences.

Interviewer: Because there's some real danger from caffeine overdoses, isn't there?

Dr. Barbara Crouch: Yes there is, and caffeine is the most common psychoactive substance in the world. Almost all of us consume some sort of caffeine on a regular basis, whether that is in coffee, or tea, or in a soft drink, or even chocolate. So it is common, and we use caffeine as a pick me up to avoid sleeping, and normally we tolerate it fairly well.

Now we have an explosion of other sources of caffeine, and I think vulnerable teens may not recognize that they are adding so much more caffeine into their diet. There are so many energy drinks; they are marketed to toward young adults. Their marketing is sort of edgy, and they have lots and lots of caffeine, even more caffeine than you might find in a very large cup of coffee from Starbucks.

So if you were to look at the label of an energy drink you might see a variety of natural substances listed. It may also list caffeine itself, and you don't really know how much caffeine you're consuming, because there is synthetic caffeine, and then there might be a variety of natural sources. So the total amount of caffeine isn't clear.

And then we have other natural stimulants, and so a lot of the energy drinks have boosted their products by adding additional stimulants, like ginseng, and synephrine, taurine, and a variety of other things that sort of add to and contribute to that stimulant load, if you will. So it's hard to know exactly how much you're ingesting.

Some of the products, if you were to look at the cans, you'll look at the serving size; they will tell you that you open up a can and it contains two servings. I don't know about you, but I don't open a can of something and not finish it. So again, there's this sort of almost deception as to how much caffeine may be included in a product.

Interviewer: It sounds like with energy drinks the risk for caffeine overdose increases.

Dr. Barbara Crouch: Yes, caffeine is a stimulant, and as a stimulant it can exert a lot of adverse effects. In toxicology we like to say that the dose makes the poison. So the more we take the more likely we are to experience an adverse effect, or even a toxic effect. As a stimulant, you know, the first thing that you might feel if you drank too much caffeine is you might feel a little jittery. You might be shaky. You might have a tremor. And as you increase that load your heart starts to beat fast, and it may be very irregular. So somebody who has an underlying heart problem is at risk. And then in very high doses you can seize. So again, it's sort of the dose.

When I drink a cup of coffee I might have a strong cup of coffee, but it's a warm beverage that I am sipping over a period of time. And as I'm ingesting the caffeine, my body is metabolizing the caffeine. What happens with the energy drinks is a lot of them, especially again with the young adults, they tend to drink them fast, and they may have more than one. So all of a sudden the amount of caffeine being consumed and absorbed into the body is much higher over a shorter period of time.

So then you have to think about it, that that's the energy drink. What other sources of stimulants are you taking in? Have they had a cup of coffee or tea or a soft drink that has caffeine? Are they taking any over-the-counter medications? You can buy caffeine as an over-the-counter drug and take it as a stay-awake drug. And a lot of kids in school do, to stay up to study for exams. There are now food products that have caffeine in them, like Cracker Jack'D that has 100 milligrams of caffeine in a packet.

And then we have stimulants, or medications that are stimulants, that can add to and contribute to adverse effects, and those include a lot of our ADHD drugs. So if you have a teenager who has ADHD and is on an ADHD drug, and they add a bunch of caffeine, they are more likely to have an adverse effect than somebody who isn't on those medications. So there are a lot of factors that play into somebody's risk for having an adverse effect.

Interviewer: The adverse effects have real consequences on a person's health, but you mentioned toxic effects earlier. At what point do adverse effects become toxic effects?

Dr. Barbara Crouch: Well that's a good question. And there is no good answer to that. I think we have an idea of certain amounts of caffeine if ingested all at once can be a problem. But it's going to depend on each individual. It's going to depend on whether they are on other medications. It's going to depend on how much total caffeine they are ingesting. And it's going to depend on their underlying health. So I know of at least one report out there of a teenager who died. They have suggested that it was due to an energy drink, and it turned out that the teenager had an undiagnosed heart problem. That probably contributed to her death, potentially. So I think underlying health is also an important component.

Interviewer: So obviously there are going to be certain people and groups of people that are going to be more vulnerable to caffeine overdose. You mentioned teenagers; you mentioned people who might be taking a stimulant drug for a medical condition, or people with heart conditions. Are there any other vulnerable populations or people that you can think of?

Dr. Barbara Crouch: Well certainly very young children. We don't typically give our children coffee or soft drinks at a young age. But you can imagine if you have an attractive container that's out and about in the house, that a toddler when they're exploring their environment might find that attractive and drink that. And so again, a fair amount of caffeine that might way too much for that small child.

Interviewer: I appreciate you visiting with us today, Dr. Crouch. Do you have any final thoughts that you'd like to share with us about caffeine?

Dr. Barbara Crouch: Well I think the most important thing is people need to be aware of the fact that it is a stimulant, and that it has the potential to cause adverse effects when ingested in large amounts.

Interviewer: And of course if you are worried about somebody that may have had a caffeine overdose, whether it be a child or adult, you can always call the Utah Poison Control Center. The number is universal and works in whatever state you are in, and the number is 800-222-1222.

Dr. Barbara Crouch: Great, yes, absolutely.

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