Rare Complications of Fatal Caffeine Intoxication

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.

A case of esophageal perforation caused by suicidal caffeine poisoning in a teenager

“…Caffeine is one of the most widely used drugs and a well-known stimulant that belongs to the plant alkaloid family. The substance is contained in some commonly consumed powder, tablets, food or beverage, such as coke and chocolate 4) . This ubiquity indicates that the amount of caffeine consumed, even in unintentional ingestion, may be much larger than felt by the consumers.…”

Medical and forensic aspects of energy drinks and caffeine shots

“…In cases of severe overdoses, cardiac symptoms, such as chest pain or ST segment elevation and prolonged QT interval in electrocardiographic examination, are also described, together with elevated troponin and NT-proBNP values indicating a significant life-threatening condition [79][80][81][82]. Additionally, hypokaalemia and increased blood glucose levels may occur [83,84]. Rare cases of deaths related to the overdose of energy drinks, including in the paediatric population, have been reported [84,85].…”

“…In such cases, differentiation from other potential causes of sudden cardiac death is usually required [84]. Cases of perforation in the gastrointestinal tract due to the high concentration of caffeine after ingesting energy-boosting products have also been reported [83]. Pre-disposing factors to death from a high dose of caffeine in energy drinks may include silent heart defects, conduction disorders, and cardiomyopathies [84,[89][90][91].…”