• Profile

Death by caffeine: Who is most at risk?

MDlinx Apr 04, 2024

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.

Cappelletti S, Piacentino D, Fineschi V, et al. Caffeine-related deaths: manner of deaths and categories at risk. Nutrients. 2018;10(5):611.


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.

Grémain V, Chevillard L, Saussereau E, et al. Massive suicidal ingestion of caffeine: a case report with investigation of the cardiovascular effect/concentration relationships. Clinical Toxicology. 2021;59(10):937–941.

In another, a 23-year-old man developed complications after ingesting 24 g of caffeine. He recovered after being resuscitated and provided hemodialysis.

Khan S, Babu K, Sidhu R, et al. Caffeine intoxication treated with hemodialysis. Seminars in Dialysis. 2023;36(5):414–418.



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.

Costantino A, Maiese A, Lazzari J, et al. The dark side of energy drinks: a comprehensive review of their impact on the human body. Nutrients. 2023;15(18):3922.

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.

Walrath-Holdridge M. Panera Charged Lemonade linked to alleged deaths, lawsuits: everything that's happened so far. USA Today. January 22, 2024.

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.


Only Doctors with an M3 India account can read this article. Sign up for free or login with your existing account.
4 reasons why Doctors love M3 India
  • Exclusive Write-ups & Webinars by KOLs

  • Nonloggedininfinity icon
    Daily Quiz by specialty
  • Nonloggedinlock icon
    Paid Market Research Surveys
  • Case discussions, News & Journals' summaries
Sign-up / Log In
M3 app logo
Choose easy access to M3 India from your mobile!

M3 instruc arrow
Add M3 India to your Home screen
Tap  Chrome menu  and select "Add to Home screen" to pin the M3 India App to your Home screen