Effects of commercial energy drink consumption on athletic performance and body composition.

Energy drinks are frequently marketed to individuals interested in athletics and an active lifestyle. From 2001 to 2008, estimates of energy drink use in adolescent to middle-aged populations ranged from 24% to 56%. Most energy drinks feature caffeine and a combination of other components, including taurine, sucrose, guarana, ginseng, niacin, pyridoxine, and cyanocobalamin. This article examines the evidence for 2 commonly purported uses of energy drinks: athletic performance enhancement and weight loss. Observed ergogenic benefits of energy drinks are likely attributable to caffeine and glucose content. There is conflicting evidence regarding the impact of energy drinks on weight loss, although some data suggest that combining energy drink use with exercise may enhance body fat reduction. As with any pharmacologically active substance, energy drinks are associated with adverse effects. Combining energy drinks with alcohol exacerbates safety concerns and is an increasingly common practice contributing to toxic jock identity among college-aged male athletes. Practitioners should monitor identified populations likely to consume these loosely regulated beverages.

Clinical response to unintentionally rapid infusion of drotrecogin alfa (activated).

PURPOSE: The case of a patient with severe sepsis who received a bolus dose of 184 microg/kg of drotrecogin alfa (activated) over one hour is reported. SUMMARY: An 84-year-old woman who had undergone right total knee replacement was admitted to the hospital from a rehabilitation facility with an initial diagnosis of mental status changes and a suspected urinary tract infection. Examination of the patient's incision from her recent knee surgery revealed a discharge, and a culture was obtained. The patient was diagnosed with sepsis, intubated, and transferred to the intensive care unit. Multiple antibiotics were administered, but the patient's condition continued to deteriorate. In addition, the patient developed acute renal failure, required a ventilator, had cyanotic limbs, and had partially compensated metabolic acidosis. On hospital day 7, drotrecogin alfa (activated) was initiated. She inadvertently received an infusion of 184 microg/kg of drotrecogin alfa over 1 hour. Nine hours later, she received drotrecogin alfa 24 microg/kg/hr for 95 hours. The patient's clinical status was improved after the initial infusion. Peripheral limb cyanosis was markedly decreased, with pink, warm extremities. In addition, the patient's clinical laboratory test values improved after administration of drotrecogin alfa. However, the patient was unable to recover fully from the acute kidney failure and was discharged to hospice care. CONCLUSION: A drotrecogin alfa dose of 184 microg/kg i.v. was erroneously administered over 1 hour to a patient with sepsis. Nine hours later, a drotrecogin alfa infusion of 24 microg/kg/hr was started and continued for 95 hours. The patient improved clinically and had no apparent adverse events.

Fondaparinux therapy in a hemodialysis patient with heparin-induced thrombocytopenia type II.

PURPOSE: The successful use of fondaparinux in a hemodialysis patient with heparin-induced thrombocytopenia type II (HIT II) is reported. SUMMARY: An 85-year-old, 68-kg Caucasian woman came to the emergency department with shortness of breath and exertional chest pain radiating to the neck. Testing revealed non-ST-segment elevation myocardial infarction, severe coronary artery disease, mitral regurgitation, left ventricular dysfunction, an ejection fraction of 25-30%, and pulmonary arterial hypertension. I.V. unfractionated heparin was given for therapeutic anticoagulation per hospital protocol and discontinued on hospital day 3 before mitral valve repair and coronary bypass procedure. Postoperatively unfractionated heparin and low-molecular-weight heparin were avoided because of a reduction in the platelet count and suspicion of HIT. Instead, the patient was placed on sequential compression devices in addition to aspirin for prophylaxis of deep venous thrombosis. By postoperative day 6, the patient's platelet count dropped 76% from baseline, and the patient was found to have heparin-dependent platelet factor 4 antibodies. Argatroban infusion was initiated but discontinued after 2 days due to bleeding. Fondaparinux was ordered for anticoagulation therapy. By hospital day 8, the patient developed renal insufficiency requiring hemodialysis and adjustment of the fondaparinux regimen. During the 30-day course of fondaparinux, the patient did not experience thromboembolic events or bleeding and did not require transfusions. There was no clotting within hemodialysis membranes, and her hepatic function improved by the time of her discharge. CONCLUSION: Fondaparinux was used in a hemodialysis patient with HIT II without the development of thromboembolic, hemodialysis-clotting, thrombocytopenic, or hemorrhagic complications. The patient's platelet count remained in the normal range during the 30-day course of fondaparinux.