Death by caffeine: Who is most at risk?
Key Takeaways
Recent caffeine-related deaths have spotlighted the dangers of overconsumption, especially among vulnerable populations.
Higher rates of caffeine deaths have been seen in psychiatric patients, and among athletes and victims of child abuse.
Ultimately, caffeine-related death is typically the result of ventricular fibrillation.
People rarely die from caffeine. But recent headlines about Panera’s Charged Lemonade have left some wondering if their favorite stimulant could be putting them in harm’s way.
Real stories of over-caffeinated deaths highlight what happens when too much caffeine turns fatal. These cases provide valuable lessons for patients and their emergency responders.
Dangers and deaths are dose-dependent
Tolerance to caffeine varies, but toxicity symptoms, including seizure and cardiac arrhythmia, don’t typically occur until plasma concentrations reach 15 mg/L or higher, according to the authors of a systematic review of caffeine-related death.[]
Caffeine-induced fatalities have been associated with concentrations over 80 mg/L, typically from medications that contain caffeine, rather than from caffeinated beverages.
Aside from the unpleasant effects of “caffeinism,” such as anxiety, insomnia, and tremors, it is the cardiovascular effects of supraventricular and ventricular tachyarrhythmias that are the most lethal. The cause of death involving caffeine intoxication is usually documented as ventricular fibrillation.
Populations at risk for caffeine-fueled fatalities
The systematic review identified 92 cases of caffeine-related death. In 36 cases, suicide was identified as the cause of death. The second known cause of death was through accidental overdoses with weight loss products and other supplements. The researchers also found two reports of intentional poisonings of infants related to child abuse.
Pills, powders, and liquids were the most deadly forms of consumption, but three cases happened after intravenous administration. Aside from accidental deaths or suicides, death from caffeine most often occurred in three groups of people: infants, psychiatric patients, and athletes.
Deaths among babies and children
One of the two infant cases in the review was a 14-month-old child who presented with high levels of theophylline, delayed weight gain, chronic iron deficiency anemia, thymic involution, and severe trauma to the spleen and ribs, indicating abuse and caffeine toxicity. There was also evidence of prolonged vomiting. The amount or method of caffeine intake, however, was unknown.
In the other case, a 5-month-old baby was given caffeine tablets by his abusive father. The infant was initially admitted with persistent tachycardia and caffeine levels of 5 to 12 mg/L. He was later readmitted with subarachnoid hemorrhages and died within days.
Children have also suffered from accidental overdosing. In one case, a 5-year-old girl consumed 40 diuretic tablets she found at home. In another case, a 15-month-old baby was mistakenly given 90 mL of a 20% caffeine solution (about 18 g of caffeine) instead of the intended 90 mL of a 2% caffeine sodium benzoate solution while in the hospital.
Despite prompt medical intervention, these children did not survive.
Special considerations for psychiatric populations
Given that suicide was responsible for the largest amount of caffeine deaths in the review, it’s not surprising that people with psychiatric conditions are at heightened risk. Depression was by far the most noted condition, followed by alcohol dependence, sleep disorders, drug dependence, and eating disorders. Several of those who died by suicide with caffeine had previous suicide attempts.
Case reports have described life-saving interventions after attempted suicide with caffeine. In one case, a 47-year-old man ingested 70 g of pure anhydrous caffeine powder. After two episodes of ventricular fibrillation, his life was saved using defibrillation, tracheal intubation, and IV esmolol and norepinephrine.[] In another, a 23-year-old man developed complications after ingesting 24 g of caffeine. He recovered after being resuscitated and provided hemodialysis.[]
The review authors explain that caffeine may interact with several psychiatric medications due to competitive inhibition of the CYP1A2 enzyme. While more research is needed, there’s suspicion that caffeine may complicate treatment with antidepressants, antipsychotics, antimanic, antianxiety, and sedative drugs, potentially contributing to a higher risk of death.
Caffeine regulations for athletes and others
Athletes described in the review ranged between 18 to 44 years old, including two amateur bodybuilders, a basketball player, and a wrestler. In these cases, excessive caffeine combined with strenuous activity led to myocardial ischemia and cardiac arrest by coronary vasospasm.
The aggressive marketing of energy drinks, often glamorized by connections to extreme sports, has led to a dramatic spike in caffeine intake among young adults and adolescents.[] Despite increasing concerns about the acute and chronic effects of caffeine toxicity, safety regulations and accountability are slow to follow.
Between 2022 and 2023, three individuals under age 45 suffered cardiac arrest after consuming Panera’s Charged Lemonade.[] These incidents included two people who died and one who reported lasting complications. Currently, two lawsuits are underway, and Panera has issued new warning labels and restrictions on self service.
What this means for you
Clinicians must recognize the potentially lethal risks of caffeine intoxication and educate patients on safe consumption. Prompt treatment is required when dangerous intakes are suspected.