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Teen's energy drink-related death offers a teachable moment

In the wake of a teenager’s death from drinking too much caffeine, an expert warns about risky combinations of energy drinks and other common stimulants such as cold pills and prescription drugs.

Sean Cripe wants his son's death from drinking too much caffeine to serve as a teachable moment.

"Parents, please talk to your kids about these energy drinks," Cripe, holding back tears, said at a Monday news conference. "And teenagers and students: Please stop buying them."

Cripe's 16-year-old son, Davis, collapsed in a South Carolina high school classroom last month and died of caffeine-induced heart arrhythmia, the county coroner concluded. The teen, who had no undiagnosed heart conditions, had consumed three high-caffeine drinks over about two hours — a large Diet Mountain Dew, a McDonald's café latte, and an energy drink whose brand wasn't disclosed.

But caffeinated beverages aren't the only source of potentially dangerous stimulants that teens are using, notes Purdue University nursing professor Janet Thorlton,  who has studied what drives adolescents to use performance-enhancing substances, including energy drinks.

"Caffeine can't be blamed as the sole problem," she said. "It's a chemistry thing, with ingredients interacting. A young person may not appreciate the cumulative effect."

Among the stimulants that teenagers routinely and dangerously mix with caffeinated energy drinks, Thorlton said, are over-the-counter cold medications, dietary supplements marketed for weight-loss or fitness, and prescription drugs for asthma or attention deficit disorders.

"Stimulant drug abuse is going on under the table with kids exchanging their ADD drugs," Thorlton said. "In college, it's rampant. Kids believe they will perform better."

The American Academy of Pediatrics recommends that adolescents ages 12 to 18 consume no more than 100 milligrams of caffeine per day, about the amount in a five-ounce cup of coffee.

Colas are the only foods for which the U.S. Food and Drug Administration has set a caffeine limit — 71 milligrams in a 12-ounce can. In general, food and beverage labels have to list the presence of caffeine, but not the total amount.

Although moderate doses of caffeine can thwart drowsiness and improve alertness, too much can cause insomnia, jitters, headaches, heart palpitations, and worse. Energy-drink related emergency room visits for seizures, heart arrhythmias, and inhalation of vomit doubled from 10,068 in 2007 to 20,783 in 2011, according to national public health surveillance data that has not been updated. At least 16 deaths before Davis Cripe's had been linked to the beverages since 2004.

A tsunami of energy drink brands flooded the U.S. market after Red Bull's 1997 debut. Rather than being sold as foods, many are marketed as dietary supplements, a barely regulated category that does not require disclosure of caffeine quantity. Many energy drinks also contain caffeine-laden herbal extracts such as guarana and yerba mate.

"The average person may not realize the herbal component has a stimulant effect," Thorlton said.

Anne Barnhill, a University of Pennsylvania professor of medical ethics and health policy, called the FDA regulation of caffeine-containing products "byzantine" and urged tougher rules in a 2013 article in the Journal of Caffeine. "Strengthening  these lax labeling requirements could prevent direct caffeine-induced harm," she wrote.

Thorlton has published proposals for tightening energy drink manufacturing and labeling  — but also for enlisting teachers and coaches in warning youngsters about the dangers.

"These drinks will continue to be popular," she said. "Hopefully, raising awareness and ongoing education will help."