title: Non specific drug distribution in an autopsy case report of fatal caffeine intoxication.
abstract: Caffeine has long been recognized as an addictive substance that causes autonomic nerve effect, and is known to increase catecholamine secretion from the adrenal glands. In recent years, the risk of ingesting toxic levels of caffeine has increased because of the easy availability of analgesics, CNS (Central Nervous System) stimulant medicine and dietary supplements at shops, health stores and through online purchases. We report the death of a young female resulting from the ingestion for suicide of an online purchased sleepiness-preventing medicine containing caffeine. The autopsy findings included pulmonary edema and congestion plus cutaneous emphysema. The stomach contents included a dark-brown viscous fluid without tablet or food residue. Toxicological examination revealed the presence of caffeine in the right heart blood (154.2 μg/mL) and stomach contents (197.5 μg/mL) (lethal blood level, >80 μg/mL). The highest caffeine content was in the bile (852.3 μg/mL). Biochemical findings showed that catecholamine concentration in the peripheral blood in the iliac vein was elevated. Immunostaining of catecholamine was weak in the adrenal medulla. We recommend highlighting the toxicity risk of ingesting substances with a high caffeine concentration, and we propose that caffeine concentrations should be included in the comprehensive routine forensic toxicological tests for all cases.
authors.affiliation: Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan; Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan. Electronic address: takaki@med.osaka-cu.ac.jp.
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Yuasa
authors.affiliation: Division of Legal Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori 683-8503, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Endoh
mesh_terms: D000311:Adrenal Glands / Q000737:chemistry / Q000473:pathology; D000328:Adult; D001344:Autopsy / Q000379:methods; D002110:Caffeine / Q000032:analysis / Q000506:poisoning*; D002395:Catecholamines / Q000032:analysis*; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D017809:Fatal Outcome; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D008168:Lung / Q000473:pathology; D013405:Suicide
chemical_list: D002395:Catecholamines; D000697:Central Nervous System Stimulants; D002110:Caffeine
keywords: CNS stimulant medicine; Caffeine; Catecholamine; Pathophysiology; Toxicology