Abstract
Caffeine is considered a very safe stimulant and is widely consumed in a variety of forms, from pure caffeine to beverages and foods. Typically, death is only seen when gram quantities of caffeine are consumed, usually in suicide attempts. Even in this scenario, death is rare. However, there are special populations that need to be considered in forensic presentations, who may be at greater risk. These include poor metabolizers, people with liver disease, and people with cardiac conditions, who can die as a result of caffeine intake at levels well below what is ordinarily considered toxic. Also, caffeine intake may be hidden. For example, herbal medicines with substantial caffeine content may not disclose these concentrations on their product label. The role of caffeine in medicolegal deaths is yet to be defined, however, herbal medicines and herbal weight loss supplements may represent an underappreciated source of caffeine in this context.
Similar content being viewed by others
References
Panel EN. Scientific opinion on the safety of caffeine. EFSA J. 2015;13:120.
Dalvi RR. Acute and chronic toxicity of caffeine: a review. Vet Hum Toxicol. 1986;28:144–50.
Crippa A, Discacciati A, Larsson SC, Wolk A, Orsini N. Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. Am J Epidemiol. 2014;180:763–75.
Loftfield E, Freedman ND, Graubard BI, Guertin KA, Black A, Huang WY, et al. Association of Coffee consumption with overall and cause-specific mortality in a large US prospective cohort study. Am J Epidemiol. 2015;182:1010–22.
Boison D. Methylxanthines, seizures, and excitotoxicity. Handb Exp Pharmacol. 2011;200:251–66.
Schimpl FC, da Silva JF, Goncalves JF, Mazzafera P. Guarana: revisiting a highly caffeinated plant from the Amazon. J Ethnopharmacol. 2013;150:14–31.
Tunnicliffe JM, Erdman KA, Reimer RA, Lun V, Shearer J. Consumption of dietary caffeine and coffee in physically active populations: physiological interactions. Appl Physiol Nutr Metab. 2008;33:1301–10.
Gunja N, Brown JA. Energy drinks: health risks and toxicity. Med J Aust. 2012;196:46–9.
Pendleton M, Brown S, Thomas CM, Odle B. Potential toxicity of caffeine when used as a dietary supplement for weight loss. J Diet Suppl. 2013;10:1–5.
Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced cardiac arrhythmia: an unrecognised danger of healthfood products. Med J Aust. 2001;174:520–1.
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.
Bonsignore A, Sblano S, Pozzi F, Ventura F, Dell’Erba A, Palmiere C. A case of suicide by ingestion of caffeine. Forensic Sci Med Pathol. 2014;10:448–51.
Jabbar SB, Hanly MG. Fatal caffeine overdose: a case report and review of literature. Am J Forensic Med Pathol. 2013;34:321–4.
Silva AC, de Oliveira Ribeiro NP, de Mello Schier AR, Pereira VM, Vilarim MM, Pessoa TM, et al. Caffeine and suicide: a systematic review. CNS Neurol Disord: Drug Targets. 2014;13:937–44.
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.
Dorne JL, Walton K, Renwick AG. Uncertainty factors for chemical risk assessment: human variability in the pharmacokinetics of CYP1A2 probe substrates. Food Chem Toxicol. 2001;39:681–96.
Kashuba AD, Bertino JS Jr, Kearns GL, Leeder JS, James AW, Gotschall R, et al. Quantitation of three-month intraindividual variability and influence of sex and menstrual cycle phase on CYP1A2, N-acetyltransferase-2, and xanthine oxidase activity determined with caffeine phenoty**. Clin Pharmacol Ther. 1998;63:540–51.
Wang L, Hu Z, Deng X, Wang Y, Zhang Z, Cheng ZN. Association between common CYP1A2 polymorphisms and theophylline metabolism in non-smoking healthy volunteers. Basic Clin Pharmacol Toxicol. 2013;112:257–63.
Cornelis MC, El-Sohemy A, Kabagambe EK, Campos H. Coffee, CYP1A2 genotype, and risk of myocardial infarction. JAMA. 2006;295:1135–41.
Yang A, Palmer AA, de Wit H. Genetics of caffeine consumption and responses to caffeine. Psychopharmacology. 2010;211:245–57.
Busuttil M, Willoughby S. A survey of energy drink consumption among young patients presenting to the emergency department with the symptom of palpitations. Int J Cardiol. 2016;204:55–6.
Verbeeck RK. Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction. Eur J Clin Pharmacol. 2008;64:1147–61.
Cheston P, Smith L. Man died after overdosing on caffeine mints. Independent. 2013.
Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet. 2000;39:127–53.
George J, Murphy T, Roberts R, Cooksley WG, Halliday JW, Powell LW. Influence of alcohol and caffeine consumption on caffeine elimination. Clin Exp Pharmacol Physiol. 1986;13:731–6.
Ciszowski K, Biedron W, Gomolka E. Acute caffeine poisoning resulting in atrial fibrillation after guarana extract overdose. Przegl Lek. 2014;71:495–8.
Bryczkowski C, Geib AJ. Combined butalbital/acetaminophen/caffeine overdose: case files of the Robert Wood Johnson Medical School Toxicology Service. J Med Toxicol. 2012;8:424–31.
Berger AJ, Alford K. Cardiac arrest in a young man following excess consumption of caffeinated “energy drinks”. Med J Aust. 2009;190:41–3.
Rhidian R. Running a risk? Sport supplement toxicity with ephedrine in an amateur marathon runner, with subsequent rhabdomyolysis. BMJ Case Rep. 2011. doi:10.1136/bcr.11.2011.5093.
Berger RE, Ganetsky M. An over-the-counter weight-loss supplement with a toxicity that may be unexpectedly difficult to treat. Intern Emerg Med. 2012;7(Suppl 2):S91–2.
Seifert SM, Seifert SA, Schaechter JL, Bronstein AC, Benson BE, Hershorin ER, et al. An analysis of energy-drink toxicity in the National Poison Data System. Clin Toxicol (Phila). 2013;51:566–74.
Wolk BJ, Ganetsky M, Babu KM. Toxicity of energy drinks. Curr Opin Pediatr. 2012;24:243–51.
Yen M, Ewald MB. Toxicity of weight loss agents. J Med Toxicol. 2012;8:145–52.
Campana C, Griffin PL, Simon EL. Caffeine overdose resulting in severe rhabdomyolysis and acute renal failure. Am J Emerg Med. 2014;32:111.e3–.e4.
Chiang WF, Liao MT, Cheng CJ, Lin SH. Rhabdomyolysis induced by excessive coffee drinking. Hum Exp Toxicol. 2014;33:878–81.
Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M. Adulterants in illicit drugs: a review of empirical evidence. Drug Test Anal. 2011;3:89–96.
Davies S, Lee T, Ramsey J, Dargan PI, Wood DM. Risk of caffeine toxicity associated with the use of ‘legal highs’ (novel psychoactive substances). Eur J Clin Pharmacol. 2012;68:435–9.
Hoyte C. The toxicity of energy drinks: myth or reality? Clin Toxicol (Phila). 2013;51:729–30.
O’Malley PA. Caffeinated energy drinks: risks assumed with consumption when competing, working, and drinking. Clin Nurse Spec. 2012;26:250–3.
Suzuki H, Tanifuji T, Abe N, Maeda M, Kato Y, Shibata M, Fukunaga T. Characteristics of caffeine intoxication-related death in Tokyo, Japan, between 2008 and 2013. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2014;49:270–7.
Ishikawa T, Yuasa I, Endoh M. Non specific drug distribution in an autopsy case report of fatal caffeine intoxication. Leg Med (Tokyo). 2015;17:535–8.
Tominaga M, Michiue T, Oritani S, Ishikawa T, Maeda H. Evaluation of postmortem drug concentrations in bile compared with blood and urine in forensic autopsy cases. J Anal Toxicol. 2016;40:367–73.
Tominaga M, Michiue T, Ishikawa T, Inamori-Kawamoto O, Oritani S, Maeda H. Evaluation of postmortem drug concentrations in cerebrospinal fluid compared with blood and pericardial fluid. Forensic Sci Int. 2015;254:118–25.
Byard RW. The potential forensic significance of traditional herbal medicines. J Forensic Sci. 2010;55:89–92.
Ozdemir B, Sahin I, Kapucu H, Celbis O, Karakoc Y, Erdogan S, et al. How safe is the use of herbal weight-loss products sold over the internet? Hum Exp Toxicol. 2013;32:101–6.
Khazan M, Hedayati M, Kobarfard F, Askari S, Azizi F. Identification and determination of synthetic pharmaceuticals as adulterants in eight common herbal weight loss supplements. Iran Red Crescent Med J. 2014;16:e15344.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Musgrave, I.F., Farrington, R.L., Hoban, C. et al. Caffeine toxicity in forensic practice: possible effects and under-appreciated sources. Forensic Sci Med Pathol 12, 299–303 (2016). https://doi.org/10.1007/s12024-016-9786-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12024-016-9786-9