The Federal Institute for Risk Assessment (BfR) analysed various human trials conducted over recent years that noted cardiac dysrhythmia, seizures, kidney failure and fatalities occurred after consuming energy drinks. It called for tighter labelling to warn consumers of potential health hazards. BfR said it had repeatedly advocated the use of warning labels for demographic sub-groups such as children, pregnant women, lactating women and caffeine-sensitive individuals, who should refrain from using energy drinks. It said consumers with high blood pressure and heart disease should restrict energy drink use and called for more "robust studies". Warnings about the use of energy drinks such as Red Bull with intensive physical activity or alcoholic beverages should also be mandatory. BfR noted the regularity with which energy drinks were mixed with alcoholic beverages meant "persons no longer realistically assess their dwindling responsiveness caused by alcohol consumption under the influence of energy drinks", a problem the energy drinks sector had never taken full responsibility for. Such label warning were in place in countries like Finland and Canada, ingredient limitations were in place in France where taurine is banned. Denmark and Norway had banned or recommended banning energy drinks altogether. BfR's review took in products containing not more than 320 mg/l of caffeine, 4000 mg/l of taurine, 200 mg/l of inosite and 2400 mg/l of glucuronolactone. Consumption hazards It noted that as far back as 2002 a scan of German poison information and treatment centres revealed energy drink-related incidents included seizures, tachycardia (increased heart rate), cardiac dysrhythmia, rhabdomyolysis (decline of skeletal muscle cells), agitation, hypertonia (high blood pressure), respiratory disorders and psychotic conditions. As well as citing numerous studies demonstrating the potential hazards of energy drink consumption due to different ingredients, BfR's report notes a number of case studies where energy drinks have led to adverse reactions including death in combination with alcohol and alone. The use of energy drinks as substitutes for sports beverages was also questioned. Sports beverages supplied, "calorific energy, are consumed in larger amounts in conjunction with intensive physical activity and are, therefore, associated with the consumer conditions which are specifically contra-indicated for energy drinks." The European Food Safety Authority (EFSA) is in the process of assessing the status of energy drinks, with an EU-wide approach a possible consequence of that assessment. "This could encourage EU-wide data matching and lead to the emergence of new findings about consumer groups who may be particularly sensitive to energy drinks," Bfr said. "As far as exposure is concerned, it is pointed out that in a Scientific Committee on Food (SCF) expert report which is still valid, reference was made to the unit of 250 ml cans for energy drinks which had been the norm up to then whereas far larger packs are now sold internationally."