Abstract
Caffeine is the most widely consumed psychoactive compound worldwide. It is mostly found in coffee, tea, energizing drinks and in some drugs. However, it has become really easy to obtain pure caffeine (powder or tablets) on the Internet markets. Mechanisms of action are dose-dependent. Serious toxicities such as seizure and cardiac arrhythmias, seen with caffeine plasma concentrations of 15 mg/L or higher, have caused poisoning or, rarely, death; otherwise concentrations of 3–6 mg/kg are considered safe. Caffeine concentrations of 80–100 mg/L are considered lethal. The aim of this systematic review, performed following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement for the identification and selection of studies, is to review fatal cases in which caffeine has been recognized as the only cause of death in order to identify potential categories at risk. A total of 92 cases have been identified. These events happened more frequently in infants, psychiatric patients, and athletes. Although caffeine intoxication is relatively uncommon, raising awareness about its lethal consequences could be useful for both clinicians and pathologists to identify possible unrecognized cases and prevent related severe health conditions and deaths.
Highlights
In recent years, the risk of caffeine intoxication has increased due to the more widespread availability of analgesics, CNS stimulant medicine and dietary supplements at shops, health stores and e-markets
The first paper about lethal caffeine intoxication was published by Jokela et al in 1959 [1], and it described the accidental death of a young woman following intravenous administration of caffeine
This paper represents a comprehensive review of fatal cases due to caffeine intoxication that can be found in the literature
Summary
The risk of caffeine intoxication has increased due to the more widespread availability of analgesics, CNS stimulant medicine and dietary supplements at shops, health stores and e-markets. Lethal cases from caffeine intoxication are quite uncommon. The first paper about lethal caffeine intoxication was published by Jokela et al in 1959 [1], and it described the accidental death of a young woman following intravenous administration of caffeine. The pharmacological effects of caffeine include central nervous system and cardiac stimulation and usually occur at plasma concentrations of 15 mg/L or higher. Common features of caffeine intoxication, known as “caffeinism” (i.e., a state of chronic toxicity from excessive caffeine consumption), include anxiety, agitation, restlessness, insomnia, gastrointestinal disturbances, tremors, psychomotor agitation, and, in some cases, death. The cardiovascular effects include supraventricular and ventricular tachyarrhythmias. The direct cause of death is often described as ventricular fibrillation
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