Di Rocco et al. Journal of Medical Case Reports 2011, 5:18 http://www.jmedicalcasereports.com/content/5/1/18 Page 3 of 6 Figure 2 ECG showing normal sinus rhythm restored to 65 beats per minute after a dose of digoxin. PR interval, 129 ms; QRS, 100 ms; QTc, 398 ms. Case 2 A 16-year-old Caucasian boy with a history of atten- tion-deficit hyperactivity disorder, asthma, and allergies presented to the emergency department with intoxica- tion and vomiting after falling and sustaining minor head trauma. He had ingested an unknown quantity of Red Bull™ mixed with vodka at a party. He denied chest pain, syncope, palpitations, shortness of breath, and fever. His home medications included ampheta- mine and dextroamphetamine (Adderall XL), 30 mg daily; montelucast (Singulair), 10 mg daily; loratadine (Claritin), 10 mg daily; and doxycycline, 100 mg daily for acne. Physical examination revealed an irregularly irregular heartbeat at 160 beats per minute with no murmurs. ECG showed chaotic atrial tachycardia/atrial fibrillation with rapid ventricular response (Figure 3). Blood ethanol level was 155 mg/dl. Cardiac enzymes were unremarkable, and serum electrolytes, thyroid- function tests, and a lipid profile were normal. A car- diac ECG revealed a structurally normal heart without thrombus. Computed tomography of his brain was normal. The patient was given a bolus of 2 L of nor- mal saline, and his heart rate responded by decreasing from 160 beats per minute to 90 to 110 beats per min- ute. He remained hemodynamically stable and was placed on a cardiac monitor overnight with continued intravenous fluid support. Approximately 12 hours after presentation, he spontaneously reverted to a normal sinus rhythm (Figure 4). He remained asymp- tomatic with a normal sinus rhythm during subsequent cardiology follow-up the next week. Of note, the Division of Pediatric Cardiology at the Stony Brook University Medical Center has cared for two other cases of atrial fibrillation in healthy adoles- cents after excessive caffeine consumption in the past five years. These cases were not included in this series, as the patients were unable to be located to provide their consent. Discussion Soft drinks containing caffeine are the major source of caffeine intake in children and adolescents, and their caffeine consumption has risen exponentially in the last 30 years [8]. The fastest-growing trend is toward highly caffeinated beverages known as “energy drinks,” which differ from “sports drinks” such as Gatorade™. The gen- eral public is unlikely to be educated about the amount of caffeine in energy drinks and the possible ill effects that these drinks may cause in children and adolescents who consume them [13]. Energy drinks contain three to four times the caffeine as a typical soda and promise to boost performance and to enhance metabolism. Energy drinks like Full Throttle™, Red Bull™, SoBe No Fear™, and Monster™ typically contain a combination of caf- feine, carbohydrates, B vitamins, amino acids, and other ingredients. One 8.2-ounce can of Red Bull™ contains