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Study Title and Description

Caffeine fatalities--four case reports.



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on acute toxicity*?
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Primary Publication Information
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TitleData
Title Caffeine fatalities--four case reports.
Author P Holmgren,L Nordén-Pettersson,J Ahlner,
Country
Year 2004
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Acute Toxicity - Study Design Details
Arms
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 14687776
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What outcome is being evaluated in this paper? Acute
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What is the objective of the study (as reported by the authors)? we report four fatal intoxications with caffeine which we have seen during the last year
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) collected blood from femoral vein, analyzed for caffeine by capillary gas chromatography with a nitrogen specific detector; not clear if histopath was completed on all 4 corpses.Toxicologic analyses summarized
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How many outcome-specific endpoints are evaluated? 1
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) concentration of caffeine in femoral blood
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes The authors conclude that caffeine intoxication was the cause of death in each case, but only one exposure was solely to caffeine. All 4 were ethanol and/or drug abusers
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Clinical Clinical
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Physiological
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Other
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What is the study design? Case report
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Objective
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Optional: Name of Method or short description caffeine in femoral blood
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Caffeine (general)
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Coffee
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Chocolate
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Energy drinks
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Gum
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Medicine/Supplement Medicine/Supplement
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Soda
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Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults Adults
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Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) no control these are case studies and concentration exposed to was based on pills purchases vs. pills missing
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) ethanol and drug abuse
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Provide a general description of results (as reported by the authors). In all 4 case reports caffeine was found in concentrations considered to be lethal. In 2/4 cases the manner of death was suicide and 2/4 were uncertain.
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? an overdose of tablets containing caffeine cause fatal intoxications; 150-200 ug/g caffeine in blood in fatalities compared to a cup of coffee plasma level of 1-2 ug/g. The authors state that it is used for intentional suicide but there are also cases where accidental intoxication must be suspected. Reports of caffeine intoxication are not very frequent.authors recommend caffeine be part of routine screening at forensic tox labs and question shy pure caffeine should be readily available when there is no medical need.
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What were the sources of funding? none reported, this was a forensic pathology case report
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What conflicts of interest were reported? none reported
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Does the exposure (dose) need to be standardized to the SR? No
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest).
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  10 g caffeine = lethal
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. helpful discussion of PK in relation to a cup of coffee
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What is the importance of the study with respect to the adverseness of the outcome? Important
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Baseline Characteristics
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Results & Comparisons

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Adverse Events
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