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Study Title and Description

Death of a young man after overuse of energy drink.



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on acute toxicity*?
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Primary Publication Information
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TitleData
Title Death of a young man after overuse of energy drink.
Author S Avcı,R Sarıkaya,F Büyükcam,
Country
Year 2013
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Acute Toxicity - Study Design Details
Arms
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 23896014
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What outcome is being evaluated in this paper? Acute
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What is the objective of the study (as reported by the authors)? Nowadays, interest to energy drinks progressively increased. The main consumers are young, athletes, and students. Most of the consumers use energy drinks involuntary and unaware of their severe adverse effects in overdose. Herein, we reported a 28-year-old-man who was consumed an excess amount of energy drink.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) A 28-year-old-man was admitted to the emergency department with cardiac arrest. The patient had drunk 3 cans of 250-mL energy drink 5 hours before the basketball match; he had palpitation and nausea before the match. After 30 minutes of the match, during the break, the patient lost his consciousness, and in 15 minutes, he was brought to the emergency department. He was regularly consuming the same energy drink 1 in a day for 7 months. The caffeine of a single can of the used energy drink was 80 mg/250 mL (32 mg/100 mL). On admission, he was unconscious and not breathing, his heart was not beating, and ventricular tachycardia rhythm was seen on the monitor. The patient was intubated, and by biphasic cardioversion with 200 J, normal cardiac rhythm was achieved. In his transthoracic echocardiographic examination, cardiac functions were normal, there was no any cardiac wall motion abnormalities, hypertrophy was seen in the left ventricle and anteroseptal part of the hearth, there was no any valvular abnormalities, and there was no any pulmonary congestion finding. The patient is hospitalized in the coronary intensive care unit. Coronary angiography was not performed.
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How many outcome-specific endpoints are evaluated? 5
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Nausea
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List additional health endpoints (separately). death
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List additional health endpoints (separately)
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Notes
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Clinical Clinical
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Physiological Physiological
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Other
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What is the study design? Case report
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Objective
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Optional: Name of Method or short description
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Caffeine (general)
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Coffee
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Chocolate
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Energy drinks Energy drinks
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Gum
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Medicine/Supplement
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Soda
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Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults Adults
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Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) NA - case report
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) NA
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Provide a general description of results (as reported by the authors). The caffeine of a single can of the used energy drink was 80 mg/250 mL (32 mg/100 mL). On admission, he was unconscious and not breathing, his heart was not beating, and ventricular tachycardia rhythm was seen on the monitor. The patient was intubated, and by biphasic cardioversion with 200 J, normal cardiac rhythm was achieved. In his transthoracic echocardiographic examination, cardiac functions were normal, there was no any cardiac wall motion abnormalities, hypertrophy was seen in the left ventricle and anteroseptal part of the hearth, there was no any valvular abnormalities, and there was no any pulmonary congestion finding. Laboratory results were as follows: pH 7.12; pCO2 21.7 mm Hg, pO2 111.6 mm Hg, HCO3 15.3 mmol/L, troponin-I N50 ng/mL, D-dimer 16.889 mg/L, and glucose 234 mg/dL. In his neurologic examination, there was no any pathological reflex, Glasgow Coma Scale was 3, pupils were isochoric, and light reflex was normal. Brain computed tomography finding was normal. The patient is hospitalized in the coronary intensive care unit. Coronary angiography was not performed. In 3 days of follow up, there was no any electrocardiographic change. On the third day, the patient died after a sudden cardiac arrest.
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? In conclusion, energy drink consumers should be informed about their severe adverse effects in case of overuse. In case of cardiac dysrhythmia, early intervention will decrease mortality and morbidity.
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What were the sources of funding? NA
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What conflicts of interest were reported? NA
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Does the exposure (dose) need to be standardized to the SR? Yes
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest). 80 mg x 3 energy drinks (250 mL ea.)= 240 mg
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  Nausea LOAEL = 240 mg Loss of consciousness LOAEL = 240 mg ventricular tachycardia LOAEL = 240 mg cardiac arrest LOAEL = 240 mg death LOAEL = 240 mg
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot.
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What is the importance of the study with respect to the adverseness of the outcome? Critcal
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