Case study chronicles first brain bleed tied to energy drinks

November 28, 2016 by Bob Shepard, University of Alabama at Birmingham
Case study chronicles first brain bleed tied to energy drinks
Venkatraman says the drink contains a high level of caffeine, along with a variety of other ingredients, many of which are associated with increases in blood pressure. Credit: University of Alabama at Birmingham

Investigators at the University of Alabama at Birmingham have presented the first case study of a patient experiencing a hemorrhagic stroke—a brain bleed—following consumption of an energy drink.

In an article in press in the American Journal of Emergency Medicine, the UAB physicians detail the case of a 57-year-old man who developed an within 15 minutes of drinking a popular energy drink.

The patient presented at a local emergency department and was transferred to the stroke unit at UAB with symptoms of sensory changes (tingling and numbness) in the right arm and leg, along with ataxia (shaky gait and movement). A CT scan revealed a small hemorrhage near the left thalamus.

"The man reported that his symptoms began about 15 minutes after drinking an energy drink, the first time he had consumed this particular product, as he was about to do yardwork," said Anand Venkatraman, M.D., a fourth-year resident in the Department of Neurology at UAB and the lead author of the study.

Venkatraman says the drink contains a high level of caffeine, along with a variety of other ingredients, many of which are associated with increases in blood pressure.

"This particular drink contains several supplements for which we have little understanding of their potential interactions with each other or with caffeine," Venkatraman said. "One is structurally similar to amphetamines, and several are known to stimulate the sympathetic nervous system."

The sympathetic nervous system regulates what is known as the "flight or fight" response. When faced with an urgent, potentially dangerous situation, the body gears up to either take extraordinary action (fight) or run away (flight).

"The body begins to marshal all of its resources to respond to the situation at hand—boosting strength and alertness, for example—in part by raising blood pressure to increase blood flow," Venkatraman said. "For a patient who may be at risk for vascular disease, this increase in blood pressure could be potentially dangerous, as a rise in blood pressure can affect an already weakened blood vessel to the point that it ruptures."

Ingredients in the drinks that are suspected to influence the sympathetic include β-phenylethylamine hydrochloride, yohimbine and .

"These ingredients are supplements and, as such, are not regulated by the government to the same degree that medications are," Venkatraman said. "We don't have good information on dosing for some of these supplements. We don't know how much is too much, for example, especially in populations with varying degrees of risk."

Another issue is serving size. The manufacturer's label says the bottle contains two servings, but the patient reported that he drank the full 8 oz. bottle at one time, a behavior that Venkatraman believes is common.

"The warning here is that we do not fully understand how some of these ingredients interact with other compounds," Venkatraman said. "Nor do we have enough information on maximum dosages, especially for individuals with underlying health issues. Consumers need to be aware of the ingredients in the drinks if they choose to use them, and check with their physician if they have questions. They should also follow the manufacturer's recommendations."

In this case, the patient had a history of elevated and was at increased risk for vascular disease. Several months after the incident, the patient reported that he still had some residual effects from the incident.

"I am not anti-energy drink," Venkatraman said. "In fact, I use them myself on occasion. But I strongly urge consumers to read the label and be informed. Don't take unnecessary risks with your health. There is potential for a serious outcome."

Explore further: Are energy drinks safe?

Related Stories

Are energy drinks safe?

September 16, 2016
Despite reported health concerns, the popularity of energy drinks is steadily climbing. Between 2008 and 2012, for example, energy drink sales jumped by 60% in the United States. By 2017, annual energy drink sales in the ...

Cardiac complications from energy drinks? Case report adds new evidence

August 2, 2016
The high levels of caffeine in energy drinks may lead to cardiac complications, suggests a case report in the July/August Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM).

Energy drinks raise resting blood pressure, with effect most dramatic in those not used to caffeine

March 13, 2015
Healthy young adults who don't consume caffeine regularly experienced greater rise in resting blood pressure after consumption of a commercially available energy drink—compared to a placebo drink—thus raising the concern ...

Man develops acute hepatitis from consuming too many energy drinks

November 1, 2016
A 50-year-old man was admitted to the emergency department with acute hepatitis, most likely due to his intake of 4-5 energy drinks every day for three weeks, reveal doctors writing in the journal BMJ Case Reports.

One energy drink may increase heart disease risk in young adults

November 8, 2015
New research shows that drinking one 16-ounce energy drink can increase blood pressure and stress hormone responses significantly. This raises the concern that these response changes could increase the risk of cardiovascular ...

Energy drinks trigger abnormal heart rhythm, rise in blood pressure

March 3, 2016
A clinical trial led by researchers from University of the Pacific and David Grant Medical Center adds to the evidence that energy drinks may be bad for your heart. Results of the study will be presented today at a meeting ...

Recommended for you

Drinking alcohol makes your heart race

March 18, 2018
The more alcohol you drink, the higher your heart rate gets, according to research presented today at EHRA 2018 Congress, organized by the European Society of Cardiology.

Exposure to low levels of BPA during pregnancy can lead to altered brain development

March 17, 2018
New research in mice provides an explanation for how exposure to the widely used chemical bisphenol A (BPA) during pregnancy, even at levels lower than the regulated "safe" human exposure level, can lead to altered brain ...

The coffee cannabis connection

March 15, 2018
It's well known that a morning cup of joe jolts you awake. But scientists have discovered coffee affects your metabolism in dozens of other ways, including your metabolism of steroids and the neurotransmitters typically linked ...

Study of nearly 300,000 people challenges the 'obesity paradox'

March 15, 2018
The idea that it might be possible to be overweight or obese but not at increased risk of heart disease, otherwise known as the "obesity paradox", has been challenged by a study of nearly 300,000 people published in in the ...

Smoking linked with higher risk of type 2 diabetes

March 15, 2018
The prevalence of diabetes has increased almost 10-fold in China since the early 1980s, with one in 10 adults in China now affected by diabetes. Although adiposity is the major modifiable risk factor for diabetes, other research ...

Key drivers of high US healthcare spending identified

March 13, 2018
The major drivers of high healthcare costs in the U.S. appear to be higher prices for nearly everything—from physician and hospital services to diagnostic tests to pharmaceuticals—and administrative complexity.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

not rated yet Nov 30, 2016
A solitary case report on one middle-aged man, whose long-term medical history is unknown, does not constitute scientific evidence. Most mainstream energy drinks have about half as much caffeine as a similar size coffeehouse coffee. Regarding the other ingredients contained in these products, many are naturally occurring ingredients."

"The FDA, European Food Safety Authority and other regulatory agencies around the globe have affirmed the safety of these beverages and their ingredients. Even so, America's leading energy drink manufacturers voluntarily go far beyond all federal requirements when it comes to responsible labeling and marketing practices.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.