I'm in and I'm out

I had a 17 year old male patient admitted at the Pediatric ICU of a hospital. It was a case of ethanol/alcohol intoxication. The boy had a drinking spree with his friends with Cobra Energy Drink mixed with brandy and later on gin. The pharmacologic effect of the energy drink was immediate as all caffeine are. Because of that, the patient felt strong and thought that he could down more liquor later on. The peak effect of ethanol and alcohol set it much later. With more alcohol being downed, the boy had loss consciousness in a day and ended up intubated in the ICU.

In May 27, 2008, the New York Times had published an article entitled "Taste for Quick Boost Tied to Taste for Risk" (www.nytimes.com/2008/05/27/health). The article reports that "health researchers have identified a surprising new predictor for risky behavior among teens and young adults - the energy drink".

These super-caffeinated energy drinks come in various names. In the Philippines, they are more popularly branded as Red Bull, Cobra, Extra Joss and Lipovitan.

Side effects of the drink are linked to reports of nausea, abnormal heart rhythms, palpitations, sweating and ER visits.

"New research suggests the drinks are associated with a health issue far more worrisome than the jittery effects of caffeine - risk taking."

"In March, the Journal of American College Health published a report on the link between energy drinks, athletics and risky behavior with the associated of "toxic jock" behavior, which is a constellation of risky and aggressive behaviors including unprotected sex, substance abuse and violence."

In the Philippines, a product manager of mine who used to work for an energy drink company said that the biggest consumers of these drinks were not in the supermarkets but in the clubs. Kids who go clubbing are into this new cocktail craze - energy drink mixed with alcohol. The kick you get from the energy drink is immediate and when laced with alcohol, the inebriation takes effect long after the party is over.

In the US, the American Beverage Association claims that "its members don't market energy drinks to teenagers as the intended audience is adults". But in the local market where the buck stops when the bucks don't come in, the intended audience to the greedy marketing sector will always be - everyone!

All the energy drinks are not regulated and are available locally in even a grocery store. These drinks have many ingredients but some contain stimulants like guarana (which also has an appetite suppressing property), gingko and ginseng, amino acids, vitamins and most importantly caffeine.

The latter is a drug in itself and the higher content of caffeine should be classified as a regulated substance (as we should be classifying nicotine and alcohol). The caffeine content varies and a 12 ounce serving of Coke or Pepsi contains 34-38 mg caffeine. Red Bull has 116 mg! In the US, Wired X344 contains 258 and Spike Shooter has 428 mg of caffeine in 12 ounces.

"At Starbucks the caffeine content is 75 mg in a 12 oz cappuccino or latte or as much as 250 mg in a 12 oz brewed coffee."

Where's the fuzz? Energy drinks are served cold and hence are consumed in larger amount and more quickly that hot drinks that is sipped. The increasing popularity of mixing energy drinks with alcohol can make alcohol users feel less drunk, but motor coordination and visual reaction time are just as impaired as when they drink alcohol by itself.

"Dr. Mary Claire O'Brien surveyed energy drink and alcohol use among college students at 10 universities in North Caroline and the study published this month in Academic Emergency Medicine, showed that students who mixed energy drinks with alcohol got drunk twice as often as those who consumed alcohol by itself and were far more likely to be injured or require medical treatment while drinking. Energy drink mixers were more likely to be victims or perpetrators of aggressive sexual behavior. The effect remained even after researches controlled for the amount of alcohol consumed."

The story line is simple, as our youth engage in riskier behavior without taking into consideration their health. Media should be more abreast with issues like these, rather than emphasizing on ratings of the word war between Wilma Galvante and stage-mom Anabelle Rama.

As for my patient, he wanted to just be "in". Now, he's "out".