Skip to main content
Top
Published in: Forensic Science, Medicine and Pathology 3/2017

01-09-2017 | Case Report

Nonfatal and fatal intoxications with pure caffeine – report of three different cases

Authors: Jan Magdalan, Marcin Zawadzki, Rafał Skowronek, Magdalena Czuba, Barbara Porębska, Tomasz Sozański, Paweł Szpot

Published in: Forensic Science, Medicine and Pathology | Issue 3/2017

Login to get access

Abstract

Caffeine is not usually perceived as a drug by most people because it is found in many foods and drinks, including caffeinated energy drinks, as well as in over the counter analgesics and cold preparations. Recently in Poland it has become increasingly common to take pure caffeine, bought through online stores, as a psychoanaleptic. This creates a much higher risk of severe and even fatal poisoning in comparison with the risk associated with the abuse of food products and non-prescription medicines containing low doses of caffeine. This paper presents three different cases of poisoning that occurred when pure caffeine was taken as psychostimulant; in cases 1 and 2 poisoning was the result of a single overdose, while in the case 3 poisoning resulted from a cumulative overdose. In the case 1 there was a severe intoxication (persistent vomiting, hypotension, tremor), and the concentration of caffeine in the blood was found to be 80.16 μg/mL. The patient was treated using hemodialysis, which caused a rapid decrease in blood levels of caffeine and relief of the clinical symptoms of poisoning. Cases 2 and 3 were fatal poisonings, and recorded levels of caffeine in post mortem blood samples were 140.64 μg/mL and 613.0 μg/mL. In case 2 the patient died 10 min after admission to hospital as a result of sudden cardiac arrest, which was preceded by an attack of convulsions, and in case 3 death occurred in home and was also sudden in nature. Taking pure caffeine as a stimulant is associated with a high risk of overdose and the development of serious and even fatal poisoning, and those using pure caffeine are generally completely unaware of these risks. In such cases, death is usually sudden due to functional mechanisms.
Literature
1.
go back to reference Engebretsen KM, Harris CR. Caffeine and related nonprescription sympathomimetics. In: Ford MD, Delaney KA, Ling LJ, Erickson WB, editors. Clinical toxicology. Philadelphia: Saunders Company; 2001. p. 310–5. Engebretsen KM, Harris CR. Caffeine and related nonprescription sympathomimetics. In: Ford MD, Delaney KA, Ling LJ, Erickson WB, editors. Clinical toxicology. Philadelphia: Saunders Company; 2001. p. 310–5.
2.
go back to reference Leikin JB, Paloucek FP. Poisoning & toxicology handbook. Hudson: Lexi-Comp Inc.; 2002. p. 311–2. Leikin JB, Paloucek FP. Poisoning & toxicology handbook. Hudson: Lexi-Comp Inc.; 2002. p. 311–2.
3.
go back to reference Musgrave IF, Farrington R, Hoban C, Byard RW. Caffeine toxicity in forensic practice: possible effects and under-appreciated sources. Forensic Sci Med Pathol. 2016;12:299–303.CrossRefPubMed Musgrave IF, Farrington R, Hoban C, Byard RW. Caffeine toxicity in forensic practice: possible effects and under-appreciated sources. Forensic Sci Med Pathol. 2016;12:299–303.CrossRefPubMed
4.
5.
go back to reference Mack RB. A tasteless proposal: Caffeine overdose. Am J Med. 1990;89:368. Mack RB. A tasteless proposal: Caffeine overdose. Am J Med. 1990;89:368.
6.
go back to reference Jabbar SB, Hanly MG. Fatal caffeine overdose: a case report and review of literature. Am J Forensic Med Pathol. 2013;34:321–4.CrossRefPubMed Jabbar SB, Hanly MG. Fatal caffeine overdose: a case report and review of literature. Am J Forensic Med Pathol. 2013;34:321–4.CrossRefPubMed
7.
go back to reference Rudolph T, Knudsen K. A case of fatal caffeine poisoning. Acta Anaesthesiol Scand. 2010;54:521–3.CrossRefPubMed Rudolph T, Knudsen K. A case of fatal caffeine poisoning. Acta Anaesthesiol Scand. 2010;54:521–3.CrossRefPubMed
8.
go back to reference Campana C, Griffin PL, Simon EL. Caffeine overdose resulting in severe rhabdomyolysis and acute renal failure. Am J Emerg Med. 2014;32(111):e3–4. Campana C, Griffin PL, Simon EL. Caffeine overdose resulting in severe rhabdomyolysis and acute renal failure. Am J Emerg Med. 2014;32(111):e3–4.
9.
go back to reference Kanfer I, Dowse R. Vuma V pharmacokinetics of oral decongestants. Pharmacotherapy. 1993;13:116S–28S.PubMed Kanfer I, Dowse R. Vuma V pharmacokinetics of oral decongestants. Pharmacotherapy. 1993;13:116S–28S.PubMed
11.
go back to reference Passmore AP, Kondowe GB, Johnston GD. Renal and cardiovascular effects of caffeine: a dose-response study. Clin Sci. 1987;72:749–56.CrossRefPubMed Passmore AP, Kondowe GB, Johnston GD. Renal and cardiovascular effects of caffeine: a dose-response study. Clin Sci. 1987;72:749–56.CrossRefPubMed
12.
go back to reference Rudy D, Lee S. Coffee and hypokalemia. J Fam Pract. 1988;26:679–80.PubMed Rudy D, Lee S. Coffee and hypokalemia. J Fam Pract. 1988;26:679–80.PubMed
13.
go back to reference Snyder SH, Skylar P. Behavioral and molecular action of caffeine: focus on adenosine. J Psychiatr Res. 1984;18:91–106.CrossRefPubMed Snyder SH, Skylar P. Behavioral and molecular action of caffeine: focus on adenosine. J Psychiatr Res. 1984;18:91–106.CrossRefPubMed
14.
go back to reference Ishigaki S, Fukasawa H, Kinoshita-Katahashi N, Yasuda H, Kumagai H, Furuya R. Caffeine intoxication successfully treated by hemoperfusion and hemodialysis. Intern Med. 2014;53:2745–7.CrossRefPubMed Ishigaki S, Fukasawa H, Kinoshita-Katahashi N, Yasuda H, Kumagai H, Furuya R. Caffeine intoxication successfully treated by hemoperfusion and hemodialysis. Intern Med. 2014;53:2745–7.CrossRefPubMed
15.
go back to reference Holstege CP, Hunter Y, Baer AB, Savory J, Bruns DE, Boyd JC. Massive caffeine overdose requiring vasopressin infusion and hemodialysis. J Toxicol Clin Toxicol. 2003;41:1003–7.CrossRefPubMed Holstege CP, Hunter Y, Baer AB, Savory J, Bruns DE, Boyd JC. Massive caffeine overdose requiring vasopressin infusion and hemodialysis. J Toxicol Clin Toxicol. 2003;41:1003–7.CrossRefPubMed
16.
go back to reference Banerjee P, Ali Z, Levine B, Fowler DR. Fatal caffeine intoxication: a series of eight cases from 1999 to 2009. J Forensic Sci. 2014;59:865–8.CrossRefPubMed Banerjee P, Ali Z, Levine B, Fowler DR. Fatal caffeine intoxication: a series of eight cases from 1999 to 2009. J Forensic Sci. 2014;59:865–8.CrossRefPubMed
17.
go back to reference Yamamoto T, Yoshizawa K, Kubo S, Emoto Y, Hara K, Waters B, et al. Autopsy report for a caffeine intoxication case and review of the current literature. J Toxicol Pathol. 2015;28:33–6.CrossRefPubMed Yamamoto T, Yoshizawa K, Kubo S, Emoto Y, Hara K, Waters B, et al. Autopsy report for a caffeine intoxication case and review of the current literature. J Toxicol Pathol. 2015;28:33–6.CrossRefPubMed
Metadata
Title
Nonfatal and fatal intoxications with pure caffeine – report of three different cases
Authors
Jan Magdalan
Marcin Zawadzki
Rafał Skowronek
Magdalena Czuba
Barbara Porębska
Tomasz Sozański
Paweł Szpot
Publication date
01-09-2017
Publisher
Springer US
Published in
Forensic Science, Medicine and Pathology / Issue 3/2017
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI
https://doi.org/10.1007/s12024-017-9885-2

Other articles of this Issue 3/2017

Forensic Science, Medicine and Pathology 3/2017 Go to the issue