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Study Title and Description

High-energy drinks may provoke aortic dissection.



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 High-energy drinks may provoke aortic dissection.
Author ZS Jonjev,G Bala,
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 23914511
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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)? report a series of three high risk cardiovascular patients who had aortic dissection (De Bakey type I and II) following significant consumption of high energy drinks. all recovered after surgery
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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) self reported symptoms, medical history, tox screen, blood pressure, heart rate, ECG and CT chest scan
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How many outcome-specific endpoints are evaluated? 6
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) self report symptoms: 1/3 had fatigue and shortness of breath; 3/3 had chest pain
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List additional health endpoints (separately). ECG and CT chest scan: 1/3 De Bakey type II and 2/3 De Bakey type I
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List additional health endpoints (separately) tox screen - negative
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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? Both
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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.) none - case study
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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) high risk of cardiovascular issues
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Provide a general description of results (as reported by the authors). Laboratory and Tox screen were negative for all three, hypertension observed in all three. ECG and CT scan confirmed aortic dissections requiring immediate surgery
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Did the authors perform a dose-response analysis (or trend/related analysis)?
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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, we report a series of three patients who had aortic dissection (De BAkey type I and II) following significant consumption of high energy drinks. All of them required emergency surgical procedure and remained stable after surgery. Authors propose that uncontrolled consumption of high energy drinks especially in patients wit underlying heart disease, could provoke potentially lethal CV events as well as acute aortic dissection.
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What were the sources of funding? none stated
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What conflicts of interest were reported? none reported
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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). 4-5 red bulls patient 1 = 80mg X 4-5 = 320-400mg/day 5-6 energy drinks patient 2 = 80 X 5-6 = 400mg - 480mg/day Several high energy drinks patient 3 = 80mg X 3 = 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.  240-480 mg/day = aortic dissection, chest pain, hypertension
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. This range is not listed with much confidence as these are self reported with not much discussion.
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What is the importance of the study with respect to the adverseness of the outcome? Low
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