Behavioral and physiologic adverse effects in adolescent and young adult emergency department patients reporting use of energy drinks and caffeine

Clin Toxicol (Phila). 2013 Aug;51(7):557-65. doi: 10.3109/15563650.2013.820311. Epub 2013 Jul 19.


Introduction: This pilot study assessed the prevalence of physiologic and behavioral adverse effects among adolescent (13-17 years) and adult (18-25 years) emergency department patients who reported energy drink and/or caffeinated-only beverage use within the 30 days prior to emergency department presentation. It was hypothesized that energy drink users would report more adverse effects than those who used only traditional caffeinated beverages such as coffee, tea, or soft drinks.

Methods: This cross-sectional pilot study was conducted in two urban emergency departments, one adult and one pediatric. Eligible patients were enrolled during a 6-week period between June and August 2010. Participants completed a tablet computer-based, self-administered, anonymous questionnaire about their past 30-day energy drink and/or caffeinated-only beverage use, substance use, and experience of 10 physiologic and 10 behavioral symptoms. Multivariable logistic regression and negative binomial regression models, adjusted for age, gender, and substance use, were created to compare the occurrence of each adverse effect between energy drink and caffeinated-only beverage users. Odds ratios (ORs) and incidence rate ratios (IRRs) were estimated.

Results: Of those enrolled, 53.3% reported consuming energy drinks, 39.1% caffeinated-only beverages, and 7.6% no energy drinks or caffeinated-only beverages within the past 30 days. In multivariable logistic regression models, energy drink users were more likely than caffeinated-only beverage users to report having "gotten into trouble at home, school, or work" in the past 30 days (OR: 3.12 [1.24-7.88]). In the negative binomial regression multivariable models, more behavioral effects were reported among drug users (IRR: 1.50 [1.18-1.93]), and more physiologic effects were reported among tobacco users (IRR: 1.42 [1.13-1.80]) and females (IRR: 1.48 [1.21-1.80]), but not among energy drink users.

Conclusions: Energy drink users and substance users are more likely to report specific physiologic and behavioral adverse effects. Emergency department clinicians should consider asking patients about energy drink and traditional caffeine usage and substance use when assessing patient symptoms.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adolescent Behavior / drug effects*
  • Adult
  • Caffeine / adverse effects*
  • Central Nervous System Stimulants / adverse effects*
  • Cross-Sectional Studies
  • Emergency Service, Hospital*
  • Energy Drinks / adverse effects*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Neurotoxicity Syndromes / epidemiology
  • Neurotoxicity Syndromes / etiology*
  • Odds Ratio
  • Pilot Projects
  • Prevalence
  • Rhode Island / epidemiology
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Smoking / epidemiology
  • Substance-Related Disorders / epidemiology
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult


  • Central Nervous System Stimulants
  • Caffeine