title: Caffeine toxicity in forensic practice: possible effects and under-appreciated sources.
abstract: Caffeine is considered a very safe stimulant and is widely consumed in a variety of forms, from pure caffeine to beverages and foods. Typically, death is only seen when gram quantities of caffeine are consumed, usually in suicide attempts. Even in this scenario, death is rare. However, there are special populations that need to be considered in forensic presentations, who may be at greater risk. These include poor metabolizers, people with liver disease, and people with cardiac conditions, who can die as a result of caffeine intake at levels well below what is ordinarily considered toxic. Also, caffeine intake may be hidden. For example, herbal medicines with substantial caffeine content may not disclose these concentrations on their product label. The role of caffeine in medicolegal deaths is yet to be defined, however, herbal medicines and herbal weight loss supplements may represent an underappreciated source of caffeine in this context.
authors.affiliation: Discipline of Pharmacology, The University of Adelaide, Frome Road, Level 5 Medical School North Building, Adelaide, SA, 5005, Australia. ian.musgrave@adelaide.edu.au.|Discipline of Anatomy and Pathology, School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, SA, 5005, Australia. ian.musgrave@adelaide.edu.au.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Musgrave
authors.affiliation: Discipline of Pharmacology, The University of Adelaide, Frome Road, Level 5 Medical School North Building, Adelaide, SA, 5005, Australia.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Farrington
authors.affiliation: Discipline of Pharmacology, The University of Adelaide, Frome Road, Level 5 Medical School North Building, Adelaide, SA, 5005, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Hoban
authors.affiliation: Discipline of Anatomy and Pathology, School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, SA, 5005, Australia.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D002110:Caffeine / Q000009:adverse effects* / Q000032:analysis / Q000493:pharmacokinetics; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000032:analysis / Q000493:pharmacokinetics; D019388:Cytochrome P-450 CYP1A2 / Q000235:genetics; D004347:Drug Interactions; D062787:Drug Overdose; D061215:Energy Drinks; D053593:Forensic Toxicology; D006801:Humans; D028321:Plant Preparations / Q000737:chemistry; D011110:Polymorphism, Genetic; D064167:Recommended Dietary Allowances
chemical_list: D000697:Central Nervous System Stimulants; D028321:Plant Preparations; D002110:Caffeine; C504573:CYP1A2 protein, human; D019388:Cytochrome P-450 CYP1A2
keywords: Caffeine; Caffeine-intoxication; Death; Forensic; Herbal medicine; Pharmacokinetics; Review; Toxicity; Undeclared sources