Thursday, May 18, 2017

Death by caffeine

Too much caffeine caused the death of a 16-year-old high school student from South Carolina who collapsed during class last month, according to the county coroner.

Davis Allen Cripe died from a caffeine-induced cardiac event causing a probable arrhythmia, Richland County Coroner Gary Watts announced in a news conference Monday. During an arrhythmia, or abnormal heart rhythm, the heart may not be able to pump enough blood to the body, and lack of blood flow affects the brain, heart and other organs.

The teen consumed three caffeine-laced drinks -- a cafe latte, a large Diet Mountain Dew and an energy drink -- in a two-hour period before collapsing in his classroom at Spring Hill High School on April 26, Watts said.

Among those at the news conference Monday was the teen's father, Sean Cripe.

"Like all parents, we worry about our kids as they grow up. We worry about their safety, their health, especially once they start driving. But it wasn't a car crash that took his life. Instead, it was an energy drink," Sean Cripe said of his son's death.

Watts said Davis had purchased the latte at McDonald's around 12:30 p.m. After that he consumed the Diet Mountain Dew and the energy drink.

Davis collapsed at the school in Chapin, near Columbia, just before 2:30 p.m. and according to Watts was pronounced dead at 3:40 p.m.

Davis' autopsy showed no undiagnosed heart conditions and that Davis was healthy and had no conditions that could have triggered by the caffeine intake. Also, no other drugs or alcohol were found in the teen's system, according to Watts.

"This was not an overdose. We lost Davis from a totally legal substance," Watts said. "Our purpose here today is to let people know, especially our young kids in school, that these drinks can be dangerous, and be very careful with how you use them, and how many you drink on a daily basis."

Sean Cripe said he hopes that if nothing else comes out of this, parents and kids will realize the dangers of caffeinated beverages.

"Parents, please talk to your kids about the dangers of these energy drinks," he said.

The American Academy of Pediatrics recommends that adolescents, age 12 to 18, should not consume more than 100 milligrams of caffeine per day. An intake of caffeine greater than that has been associated with elevated blood pressure in adolescents, Sheri Zidenberg-Cherr, nutrition specialist and vice chairwoman in the department of nutrition at the University of California, Davis, previously told CNN.

When it comes to energy drinks specifically, "children and adolescents are advised to avoid energy drinks. They can contain a significant amount of caffeine as well as other stimulants," she said. A 2014 study found an estimated 73% of children consume some kind of caffeine each day. While there is no designated standard for children, according to the US Food and Drug Administration adults can consume 400 milligrams of caffeine per day -- equivalent to four or five cups of coffee -- without experiencing side effects.

Caffeine is a stimulant that can improve alertness and mood. It can also be habit forming. Too much caffeine can cause mild symptoms such as shaky hands and an upset stomach. Severe symptoms can include high blood pressure, seizures and coma, according to the National Capital Poison Center.

See comment immediately following.


  1. Davis Allen Cripe, a healthy South Carolina teenager, downed a Mountain Dew, a cafe latte, and an energy drink — and then died suddenly last month.

    How much caffeine is deadly?
    At toxic levels — we’re talking 30 cups of coffee consumed in a short period of time — the symptoms are a lot more serious: vomiting, abdominal pain, altered consciousness, and even seizures.

    Death by caffeine, as in Cripe’s case, is typically caused by ventricular fibrillation — a rapid and irregular heart beat that disturbs the blood flow, leading to low blood pressure, loss of consciousness, and death.

    But, as Tara Haelle wrote over at Forbes, these reactions are really, really uncommon from beverages alone. (One expert told her: “I’ve never known of a case where somebody died from three caffeinated drinks.”)

    According to a review of the medical literature, there were only 45 caffeine-related deaths reported between 1959 and 2010. A more recent (2017) study (by Sweden’s Jones) found 51 — but also incredibly high levels of caffeine in the blood of the victims.

    A single cup of coffee, which contains 100 mg of caffeine, brings caffeine blood levels up to about 5 or 6 mg/L. The blood levels of the people who died of caffeine overdose, according to the 2017 paper, averaged 180 mg/L, hence the 30 cups of coffee consumed in quick succession it would take to get to those lethal levels.(continued)

  2. (continued)Energy drinks typically contain more caffeine than coffee — making them, at least in theory, easier to overdose on. A generously caffeinated energy drink might contain 300 mg of caffeine — so a person would need to quickly drink 10 to reach deadly blood levels of the stimulant. These drinks also contain other stimulants like guarana, taurine, and L-carnitine, and it’s these combinations that researchers worry the most about (but don’t fully understand), especially when mixed the beverages are mixed with alcohol.

    This mixture of beverages, according to a South Carolina coroner, lead to a “caffeine-induced cardiac event causing a probable arrhythmia.”

    Cripe’s untimely and highly unusual cause of death has sparked questions about caffeine overdose and whether it’s now easier than ever to succumb to it.

    It’s true that caffeinated drinks have become a bigger health concern — we know that the number of emergency room visits involving energy drinks has doubled in recent years. And doctors say kids and teens should never consume energy drinks because of the health risks of the caffeine and other stimulants in them.

    But caffeine overdose is extremely rare, and usually involves high doses of caffeine in tablet or powder form, not beverages. “Caffeine, alcohol, marijuana — they are legal recreational drugs,” said Alex Wayne Jones, a toxicologist with Link√∂ping University in Sweden who studied caffeine overdose. “The safest of the three is going to be caffeine.”

    Even so, medical complications from energy drinks are still rare. In Jones’ 2017 study on caffeine overdoses, about half of the deaths were suicides — and all involved caffeine in tablet or powder form, leading Jones to conclude, “It does not seem likely that toxic concentrations of caffeine can be achieved from over-consumption of caffeinated beverages alone.”

    By contrast, caffeine supplements, like powdered caffeine, pack mega-doses of caffeine, much higher than what you’d typically get from a cup of coffee or even an energy drink. They are arguably the most dangerous form of caffeine, and the most likely to lead to serious health problems.

    According to the FDA, caffeine powder is pure caffeine — and single teaspoon of the stuff is roughly equivalent to the amount in 28 cups of coffee. That’s pretty much toxic levels in a single teaspoon, which is why even small amounts of this stuff can cause symptoms much more severe than what you’d get from drinking one too many cups of coffee or tea.

    Jeffrey Goldberger, a University of Miami cardiologist and expert on the health effects of caffeine, estimated the maximum potential amount of caffeine Cripe ingested from those three drinks was about 500 mg. “This would generally not fall into a range where people would say this is a lethal dose,” he said, adding that he was skeptical caffeine was the cause of death. Instead, he thinks there was probably another unrecognized health issue at play, or that this may just be one of the rare cases of sudden death at a young age...

    The bottom line: If you stick to regular coffee, tea, and the odd energy drink — and avoid chugging these beverages in Herculean doses — you should be just fine.

  3. Davis Allen Cripe was only 16-years-old when he collapsed and died last month after drinking several highly-caffeinated drinks within a two hour time-frame. The South Carolina teen drank a latte from McDonald’s, a large Mountain Dew, and an unidentified energy drink before collapsing in class at Spring Hill High School, according to Gary Watts, the coroner of Richland County, S.C.

    In an interview with Reuters, Watts said that Cripe was healthy and there was no sign of a heart condition. Although the teen weighed just over 200 pounds, he wasn’t considered morbidly obese. Watts’s staff determined Cripe died from a “caffeine-induced cardiac event causing a probable arrhythmia.”

    Keep in mind this isn’t the case of a simple “caffeine overdose,” as many initially thought — Watts suggests it was how it was ingested.

    “We’re not saying that it was the total amount of caffeine in the system, it was just the way that it was ingested over that short period of time, and the chugging of the energy drink at the end was what the issue was with the cardiac arrhythmia,” he noted.

  4. The health police are turning their sights to energy, calling for tobacco style regulations on caffeine and bans on energy drinks for young Americans.

    Nutrition experts are calling on the federal government to heavily regulate the levels of caffeine permitted in energy drinks out of fear that the beverages are harming public health, particularly the youth. Advocates are concerned there are no rules restricting energy drink manufacturers from marketing, who face potentially fatal consequences from consuming the beverages, according to an op-ed in The Washington Post.

    Pat Crawford and Wendi Gosliner, researchers with the University of California’s Nutrition Policy Institute, want the Food and Drug Administration to crack down on energy drinks with restrictions similar to those placed on alcohol. They argue that the FDA must “ban the marketing of energy drinks to young people of all ages,” and launched a public education effort on the dangers of caffeine.

    “Caffeine is a strong and potentially dangerous stimulant, particularly for children and adolescents,” Crawford and Gosliner said in the editorial. “Making matters worse, consumers do not know the risks of the high levels of caffeine in an energy drink. Unlike coffee, energy drinks are widely marketed to adolescents, putting them at risk of extreme caffeine overload with potentially devastating cardiovascular and neurological consequences.”

    The outcry to regulate the content and sale of energy drinks comes in the wake of the tragic death of Davis Cripe, a South Carolina teen who collapsed and later died April 26 after overdosing on caffeine. The teen had consumed a large Mountain Dew, a cafe latte from McDonald’s and, according to classmates, chugged a 16-ounce energy drink over a span of two hours.

    The influx of so much caffeine into his system over such a small period of time sparked a fatal cardiac event. His death brought caffeine back into the forefront of the public health debate, particularly the levels used by popular brands like Red Bull and Monster.Crawford and Gosliner say that requiring companies to put labels showing caffeine content would be a good start, but say ultimately, stronger legal measures are needed. They note the American Academy of Pediatrics released a 2011 report saying that children and adolescents should never consume such products.

    Emergency room visits linked to energy drinks climbed from 1,494 to 20,738 between 2005 and 2011.

  5. Last month, a 16-year-old tragically lost his life after consuming an energy drink, a soda and a latte — drinks routinely consumed by and often intensively marketed to youths — all within a few hours. The boy’s heart simply couldn’t cope with the amount of caffeine in the beverages, according to the coroner.

    The teen wasn’t the first to pay a terrible price for drinking popular beverages that are commonly (but mistakenly) considered safe, but he should be the last. The government must take steps to reduce caffeine levels allowed in energy drinks; to clearly provide recommendations on safe caffeine consumption for children and adolescents; to ban the marketing of energy drinks to young people of all ages; and to help educate the public on the health risks of high caffeine intake.

    Caffeine is a strong and potentially dangerous stimulant, particularly for children and adolescents. When people think of the drug, they generally think of coffee. But less widely known is that a single serving of an energy drink (Monster Energy, Red Bull, 5-hour Energy and Rockstar, to name a few) may contain many times more caffeine than a cup of coffee.

    Making matters worse, consumers do not know the risks of the high levels of caffeine in an energy drink. Nutrition labels are not legally required to include information about caffeine content — a critical and potentially life-threatening omission. Many drink manufacturers have initiated voluntary labeling initiatives, but they are not consistently applied and do not provide adequate information to ensure consumers appropriately interpret the level of risk a beverage presents. Labels are a first step — necessary, but not sufficient.

    Unlike coffee, energy drinks are widely marketed to adolescents, putting them at risk of extreme caffeine overload with potentially devastating cardiovascular and neurological consequences. From 2005 to 2011, energy drink-related emergency-room visits rose from 1,494 to 20,783. This included high rates of unintentional exposure in children younger than 6.

    In 2011, the American Academy of Pediatrics released a report on the appropriateness of sports and energy drinks for children and adolescents, concluding that “energy drinks pose potential health risks because of the stimulants they contain, and should never be consumed by children and adolescents.” In 2013, the American Medical Association adopted a policy supporting a ban on the marketing of energy drinks to those under 18, arguing that energy drinks could lead to a host of issues in young people, including heart problems.(continued)

  6. (continued)Still, energy drink consumption has skyrocketed in recent years, even as soda consumption has begun to decline. Given the danger energy drinks pose to children and teens with no potential benefit to their health or well-being, the marketing and advertising of these products to young people must stop. We applaud efforts by Sens. Richard J. Durbin (D-Ill.), Richard Blumenthal (D-Conn.) and Edward J. Markey (D-Mass.) to move in this direction, and expect more of their colleagues in Congress to follow suit.

    Because manufacturers add caffeine to energy drinks, it is subject to regulation by the Food and Drug Administration as a food additive. In fact, the FDA has recognized the risks of high caffeine consumption and imposed a 71-milligram limit on the amount of caffeine that may be added to a 12-ounce soda. However, no limits are imposed on the caffeine content of energy drinks, and containers easily can hold 200 to 300 milligrams or more. There is no justification for this regulatory distinction. Children and adolescents drinking energy drinks need as much protection as those drinking Coke and Pepsi.

    Young people ages 12 through 17 — almost one-third of whom consume energy drinks regularly — are entitled to information that could save their lives. The FDA’s limits on added caffeine in colas should be applied to energy drinks, and the amount of caffeine added to an energy drink should be listed on its nutrition label, including a distinct front-of-package warning for drinks with caffeine levels greater than those allowed in soda. Information based on scientific testing should also be made available on the effects of energy drink additives, such as guarana and taurine, that can increase the potency and increase the effects of caffeine.

  7. After Davis Allen Cripe, age 16, collapsed and died in his South Carolina high school classroom, the coroner attributed his death to a "caffeine-induced cardiac event causing a probable arrhythmia."
    But caffeine alone was not likely the culprit. In this review, I will discuss three learning points from this event...

    Mr Cripe was said to have consumed a McDonald's latte, a diet soft drink, and an energy drink over a 2-hour period before his death. The exact dose of caffeine is hard to calculate, but upper estimates have it as no more than 626 mg—or six cups of coffee.
    That's enough caffeine to cause side effects, jitteriness, increased heartbeat, nausea, anxiety, diaphoresis, etc, but it's well below the generally accepted lethal dose of 10 g daily (100 cups of coffee)...

    I believe that Mr. Cripe had an unrecognized predisposition to the effects of caffeine. His unexplained death would have been an excellent opportunity for a molecular autopsy. In recent years, the enhanced ability to sequence DNA can point to genetic causes of death when a standard autopsy shows no obvious abnormalities.
    In a review paper, Dr Chris Semsarian (University of Sydney) and colleagues reported the proportion of sudden unexplained death in young people with negative autopsies range from 17% to 29%.[3] That is a lot of unexplained death.

    In 2012, a Mayo Clinic team reported results of DNA sequencing in 173 cases of autopsy-negative sudden deaths. They found possible mutations in genes for long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia (CPVT) in 45 cases (26%)...(continued)

  8. (continued)In 2016, researchers reported in the New England Journal of Medicine on a 3-year series of 490 cases of sudden death in children and young adults in Australia and New Zealand. They found a clinically relevant cardiac gene mutation in 31 of 113 cases (27%) that had genetic testing. A clinical diagnosis of an inherited cardiac disease was identified in 13% of the families in which an unexplained sudden cardiac death occurred.

    Similarly, a team from the Scripps Institute in San Diego u
    sed exome sequencing on blood or tissue from deceased young people (n=25) and found a likely or plausible cause of death in 40% of cases. Notably, seven of 10 cases of likely or plausible pathogenic mutations were inherited from relatives who did not die suddenly...

    Caffeine and Ectopy. Using longitudinal data, a team led by the University of California, San Francisco group studied the relationship between chronic use of caffeinated products (coffee, tea, chocolate) and cardiac ectopy. Nearly 850 individuals in the study consumed one or more caffeinated products daily. The researchers found no differences in premature atrial or ventricular beats across levels of coffee, tea, and chocolate intake...

    The most obvious message of this sad story is that we should learn as much as possible when a young person dies for unknown reasons. When standard autopsies are negative, molecular techniques may reveal important genetic causes of death.
    The second message is that we need to unlearn much of the dogma surrounding caffeine. The observational evidence is remarkably consistent: the intake of reasonable amounts of natural caffeine products, such as coffee, chocolate, and tea, does not associate with adverse health outcomes. The absence of acute cardiac effects from small randomized trials lends credence to the observational data. And . . . the possible protective effective of caffeine for incident AF is highly curious...

    First, it's reasonable to be skeptical of observational evidence surrounding caffeine. Self-selection is a possible confounding variable: if coffee once caused palpitations, it's unlikely that person becomes a habitual coffee drinker.

    Second, exposing the lack of evidence for prohibiting caffeine does not mean I condone the use of sugar- or alcohol-containing energy drinks. These drinks are the antithesis of naturally occurring. They often contain high doses of caffeine in combination with unhealthy doses of sugar or alcohol.

    Finally, I acknowledge that individuals may have specific sensitivities to caffeine. If a patient ingests caffeine and experiences adverse effects, the obvious recommendation is to avoid caffeine.