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Study Title and Description

Caffeine fatalities--do sales restrictions prevent intentional intoxications?



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--do sales restrictions prevent intentional intoxications?
Author G Thelander,AK Jönsson,M Personne,GS Forsberg,KM Lundqvist,J Ahlner,
Country
Year 2010
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 20170393
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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)? to describe fatal intoxications because of caffeine before and after a restriction was put in place from 250 or 100 tablets to 30 tablets for caffeine sold in Sweden. The secondary aim is to present a case describing the fast toxic effects occurring after ingestion
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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) Authors reviewed autopsy reports where caffeine was reported in femoral blood at >/= 80ug/g which is considered lethal (20 cases), 4 of these cases were deemed to be caffeine alone. Description of the population are given and the ug/g caffeine in femoral blood reported. Additionally a case report is described of a 21 year old female who ingested 10 g, no boo work was done, only CT scan
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How many outcome-specific endpoints are evaluated? 4
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) ventricular fibrillation - electro shock applied and resuscitation
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes no blood work was drawn to confirm caffeine level which was self reported
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Clinical Clinical
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Physiological 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? Both
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Optional: Name of Method or short description CT scan confirmed brain damage through hypoxia, seizure noted, ventricular fibrillation manifest as resuscitation efforts implemented, lactic acidosis noted
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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.) none case report
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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) no mention of other alcohol or other drugs that could have been involved or family history
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Provide a general description of results (as reported by the authors). 10 g reported as ingested by previously healthy 21 year old female who called an ambulance. Collapsed with ventricular fibrillations, electroshock implemented, hemodialysis, intubation. Prolonged hypoxic period led to hypoxic brain injury, renal function was never impaired seizures ensued. CT scan confirmed brain damage, patient died 13 days after intoxication.
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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? From autopsy data concluded that less deaths attributed to caffeine when caffeine tablets were less readily available. The case report confirms that lethal effects can occur rapidly after an overdose
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What were the sources of funding? not noted
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What conflicts of interest were reported? authors reported there were none
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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.  10g, ventricular fibrillation, hypoxia, lactic acidosis, seizure, death
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. no other comments were made of family history, possibility that dose was underestimated (caffeine was not measured in blood) or other drugs
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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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