Review of Caffeine-Related Fatalities along with Postmortem Blood Concentrations in 51 Poisoning Deaths

Publications reporting concentrations of caffeine in postmortem blood were reviewed if the cause of death was attributed to overdosing (poisoning) with drugs. Age and gender of the deceased, the manner of death (accident, suicide or undetermined) and types of co-ingested drugs were evaluated in relation to the concentrations of caffeine in blood (N = 51). The mean age (+/- SD) of the victims was 39 +/- 17.8 years (range 18-84 years) and most were female (N = 31 or 61%). The difference in mean age ofmales (42 +/- 17.2 years) and females (37 +/- 18.3 years) was not statistically significant (t = 0.811, P = 0.421). The mean (+/- SD), median and range of caffeine concentrations in postmortem blood were 187 +/- 96mg/L (180mg/L) and 33-567mg/L, respectively. The median concentration of caffeine in males (161mg/L) was not significantly different from that of females (182mg/L), z = 1.18, P = 0.235. There was no correlation between the age of the deceased and the concentration of caffeine in postmortem blood (R-2 = 0.026, P > 0.05). Manner of death was classified as suicide in 51% of cases (median blood-caffeine 185mg/L), accidental in 16% (median 183mg/L) or undetermined in 33% (median 113mg/L). The median concentration of caffeine in blood was lower when manner of death was undetermined compared with suicide or accidental (P = 0.023). Although other drugs, including ethanol, antidepressants, antipsychotics, benzodiazepines and/or ephedrine, were often identified in postmortem blood, the predominant psychoactive substance was caffeine. The deceased had ingested caffeine in tablet or powder form and it does not seem likely that toxic concentrations of caffeine can be achieved from over-consumption of caffeinated beverages alone.