Rare Complications of Fatal Caffeine Intoxication

Michał Szeremeta,Adam Sackiewicz,Petra Drobuliak,Anna Niemcunowicz-Janica,Joanna Reszeć-Giełażyn

doi:10.3390/forensicsci2010011

Michał Szeremeta, Adam Sackiewicz + Show 3 more

Open Access

https://doi.org/10.3390/forensicsci2010011

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Journal: Forensic Sciences	Publication Date: Feb 12, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: Medical University of Białystok

Abstract

Many dietary supplements may contain harmful ingredients or compounds. One of them is caffeine, a stimulant that has been utilized globally for centuries, primarily for its ability to improve mental alertness. This report described a case involving a young woman who most likely intentionally took an energy booster containing pure caffeine. Gross and microscopic examination showed extensive necrotic changes with esophageal perforation in the upper gastrointestinal tract. Harmful contents have moved to the posterior mediastinum and the left pleural cavity, causing injuries within them. Postmortem toxicological tests (gas chromatography with the mass detector—GC-MS) have shown the presence of lethal levels of caffeine in the blood (92.0 ug/mL). The remaining toxicological tests were negative.

Highlights

Dietary supplements can benefit our health, but taking supplements, including energy boosters, can involve health risks
It is almost entirely metabolized by the liver in adults, including CYP1A2, a cytochrome P450 superfamily of enzymes
The available literature does not describe massive injuries to the upper gastrointestinal tract following an overdose of caffeine

Summary

Introduction

Dietary supplements can benefit our health, but taking supplements, including energy boosters, can involve health risks. Some supplements contain substances in high concentrations, the ingestion of which can lead to severe complications or death [6]—one of the ingredients of slimming preparations might be caffeine. Numerous pieces of evidence related to the effects of the toxic substance on the deceased were found: the lower section of the thoracic part of the esophagus, just above the hiatus, presented a perforation—1.4 cm in diameter, with smooth and softening edges (Figure 1); the wall of the esophagus surrounding the perforation is intensely softening and thinning; the esophageal mucosa was covered with dense, greasy, dark-brown content; the mucous membrane of the stomach’s cardiac part and the fundus of the stomach was smooth, thinned, pale gray, with a visible brown aggregation of tiny vessels (Figure 2); the parietal pleura in the left pleural cavity was softening and presented the pale grey coloring (Figure 3).

Results

Conclusion