A case of suicide by ingestion of caffeine.
Summary (1 min read)
Introduction
- Caffeine (1,3,7-trimethylxanthine) is a natural xanthine alkaloid that acts as a central nervous system stimulant.
- Individuals may be exposed to caffeine via classical beverages (coffee, tea, chocolate, and most colas), food, prescription and over-the-counter medications, as well as herbal and dietary supplements.
- The molecule is one of the ingredients in health food products sold as appetite suppressants.
- Caffeine consumption has increased in recent years.
- In recent years, the risk of intentionally or unintentionally ingesting potentially lethal levels of caffeine has been heightened by its easy availability.
Case history
- The body of a 31 year-old Caucasian man was found in his ex-girlfriend’s apartment where he was staying although they had broken up.
- No other abnormalities were observed elsewhere in the body.
- Peripheral blood from the femoral vein, bile, urine, gastric content, and samples of certain tissues (brain, lung, liver, spleen, and kidney) were recovered for toxicological and biochemical analyses.
- Toxicological investigations performed on the blood samples revealed the presence of ethanol (0.24 g/l), caffeine (170 mg/l), and acetylsalicylic acid (169 mg/l).
- She did not have any suspicion that the drugs may have been involved in his death as she was convinced that he had died from alcohol and illicit substance intake.
Discussion
- Death from caffeine poisoning, although rare, does occur.
- Clinical effects are identifiable within 15 min and peak plasma levels are attained within 15–45 min after ingestion.
- Caffeine undergoes hepatic metabolism via N-demethylation, acetylation, and oxidation.
- This hypothesis is consistent with the aforementioned data provided by the literature, which indicates that fatal blood levels may be reached by ingesting 50–100 tablets of 100 mg pure caffeine [3, 13].
- Toxicological analyses of the femoral blood, urine, bile, and other tissue from the deceased confirmed that the active ingredient in the ingested tablets was caffeine.
Key points
- Caffeine intoxications and suicides due to ingestion of tablets with high caffeine contents, do occur, albeit rarely.
- The effects of caffeine after ingestion (or administra- tion) are rapid and pharmacological interactions with other drugs exist which can potentially raise blood caffeine levels after concomitant intake.
- High blood caffeine levels, though not lethal, should be considered as potentially being involved in the cause of death, especially in cases of pre-existing diseases or when drugs sharing the same metabolic pathway are concomitantly present.
- The correlation of medical and social history, autopsy observations, histology findings, toxicological data and postmortem biochemical results are decisive in identifying the cause of death and characterizing the pathophysiological mechanisms involved in the death process.
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220 citations
"A case of suicide by ingestion of c..." refers background in this paper
...However, to reach the dose of 3 g of ingested caffeine, a person would need to drink a large number of highly caffeinated beverages within a few hours [4, 5, 8, 10, 13, 17, 20, 21]....
[...]
...Some fatalities might result from heightened and prolonged caffeine levels attributable to multiple drugs metabolized through the same metabolic pathway [3, 4, 8, 10, 13]....
[...]
191 citations
"A case of suicide by ingestion of c..." refers background in this paper
...The direct cause of death is generally attributed to ventricular dysrhythmia, though caffeine cardiovascular effects are not limited to arrhythmogenesis [5, 11, 18]....
[...]
...However, to reach the dose of 3 g of ingested caffeine, a person would need to drink a large number of highly caffeinated beverages within a few hours [4, 5, 8, 10, 13, 17, 20, 21]....
[...]
171 citations
134 citations
"A case of suicide by ingestion of c..." refers background in this paper
...provided by the literature, which indicates that fatal blood levels may be reached by ingesting 50–100 tablets of 100 mg pure caffeine [3, 13]....
[...]
...The lethal concentration of 80–100 mg/l in blood can theoretically be reached after ingestion of 50–100 caffeine tablets containing 100 mg of pure caffeine [3, 7]....
[...]
...Some fatalities might result from heightened and prolonged caffeine levels attributable to multiple drugs metabolized through the same metabolic pathway [3, 4, 8, 10, 13]....
[...]
120 citations
"A case of suicide by ingestion of c..." refers background in this paper
...However, to reach the dose of 3 g of ingested caffeine, a person would need to drink a large number of highly caffeinated beverages within a few hours [4, 5, 8, 10, 13, 17, 20, 21]....
[...]