US teen died after drinking caffeine too quickly, coroner says | Hacker News Reader

US teen died after drinking caffeine too quickly, coroner says

bbc.com

50 pointssonabinu82 comments

Randomly, this happened in the county where I live.

But more pertinently, this seems like a horrible fluke. One time my dad, a chaplain, was called to a scene where a girl was hit in the chest by a tennis ball and killed. The ball stopped her heart. Crazy accidents happen, but that doesn't mean caffeine is suddenly the silent killer.

Very sad though.

Exactly. How many times have you heard of a person dying from caffeine? It's very unusual for any given person to have a fatal reaction to some drug. It's not at all unexpected for 1 person out of a billion to have a fatal reaction to some drug.

Depends on how much of a rockstar you are. Dave Grohl was famously hospitalized for drinking way too much coffee: http://www.nme.com/news/music/them-crooked-vultures-14-12945...

He had a conversation with his doctor about it that went something like "So how many cups of coffee do you have a day?" and his answer was "How many cups are in a pot? Because I drink like five of those..."

How does that even happen? Couldn't CPR have helped? I mean, yeah, hitting the heart might make you skip a beat, but causing the heart to stop? Does it even work like that??

The article says the teenager had no pre-existent medical (cardiac) condition. Question is : Could it be an undiagnosed, latent condition? The kid was really young and it's not usual to have teenagers do heart check-ups etc.

This story is confusing to me. There are even studies where previous heart failure patients were given acute high doses of caffeine with no adverse effects. http://jamanetwork.com/journals/jamainternalmedicine/article...

I believe the condition was looked at on autopsy, as the coroner gave said report.

My problem with this, is that even if you do an autopsy, lots of arrhythmias are not "visible", as they are conduction problems. So what's to say that the teen didn't have something like that, and while there would be no structural defects he could have had a fatal arrhythmia and died.

In similar stories I've seen, the stories usually indicates a posthumous diagnosis of some condition. It seems like there was something else going on here that caffeine triggered. That's far outside of the norm for young people though.

Perhaps they could tell a bit about the history of the heart based on the post-mortem? Just guessing though, I don't know much about medicine.

The link to caffeine seems rather tenuous, given the low dose of around 0.5 g mentioned in the article. In another incident someone was given 30 g of caffeine and they survived (https://www.theguardian.com/uk-news/2017/jan/25/students-caf...), and the same article mentions a reported death at 18 g of caffeine.

I can't really see how the causality is established from the article between the caffeine and the death.

This linked article is also interesting since the 100x overdose that almost killed those students was a direct result of a mathematical error, due to a lack of numerical common sense: "The calculation had been done on a mobile phone, with the decimal point in the wrong place". Also, the subjects who received 30g and survived, were intensely treated for the overdose in a hospital, and it sounds like they may have died without immediate professional treatment.

I wonder if the deceased had an underlying, diagnosed heart condition as well.

The article mentions that he had no preexisting heart condition.

that they knew of. I doubt that most teens with underlying heart conditions (like atrial fib) go to a cardio center.

They did an autopsy, this is the coroner's report. He would have checked for heart conditions.

The fatal dose of caffeine is fairly low, though. I'm sure it depends on body mass and such, but it's on the order of tens of grams.

The amount is roughly equal to (slightly more) than three 16 fl-oz cans of Red Bull. Certainly enough to give someone hyperactive shakes, but not normally enough to kill someone.

Tolerance might play a factor, but I can down two of these cans without too much issue && do so probably once a month or so during a particularly long workday when I haven't had enough sleep.

I wonder if dosage time was a factor. Even though the half-life of caffeine is super long my ingestion of ~0.3g typically happens over the course of 4 hours or so.

Like many others here, I consume more caffeine than this on a regular basis. I'll bet many of this kid's fellow students do too. Wouldn't be surprised if his parents and the coroner also fit that description. So it's not just the caffeine intake that's involved here. Possible factors:

* Latent undiagnosed medical condition or unusual sensitivity

* Dehydration or intense exercise

* Potentiating effect from some other ingredient, or somethig else he had consumed

* Other substances that might have shown up on a proper toxicology scan (mention of which is notably absent from this story)

Without addressing these alternate hypotheses, "it was the caffeine" is premature and a bit irresponsible.

A lot of people are questioning the coroners conclusions because they don't believe that the dose could be harmful. But he makes it clear that the issue is not the dose but the speed at which the drinks were consumed:

>"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."

Energy drinks weren't all that popular until recently, we we can expect that we are only now going to see the effects of high levels of caffeine intake on the general population.

Caffeine's ld50 is estimated to be 80-100 cups of coffee worth in a single sitting, more if any time is given to eliminate some of it. Seems like the kid just got incredibly unlucky or had some sort of latent sensitivity.

People have been drinking coffee for ages, if caffeine would be so dangerous wouldn't it be very clear by massive evidence?

Me and basically every friend I have exceeded this intake several times.

How have people consumed caffeine for ages though?

Typically people didn't start consuming it in beverages until becoming adults due to the 'bitter' taste of Coffee.

With large Soft Drink corporations having falling sales, they seek new markets. The Energy Drink Market is a booming one(see Red Bulls rise). While soda's have had caffeine content and some energy drinks existed(Bawls, Jolt), the new 'wave' of them is something different. Marketed heavily towards young men/teens(Video Games, Extreme Sports, etc).

The Coffee we consume. For most people they drank watered down drip coffee from whatever Fast Food joint. However with faltering Fast Food sales McDonalds especially has sought to enter the 'Cafe' market. By offering stronger 'traditional' Coffee beverages. Such as Lates, Espressos, etc. The article mentioned he had consumed a Late.

There's a lot of this 'oh well I or my friends have been drinking tons more caffeine' in this thread(Top Post). But I suspect that tolerance and dose has been built up over time. Caffeine addiction is real. Withdrawl is also real. Be realistic with yourself and talk to your Doctor and try to fix your sleep, or lifestyle.

Caffeine is in just about every soda available. Kids start consuming it very young, whether the parents realize it or not.

Yeah sure, I didn't start drinking coffee until very recently. Before I started every morning with a red bull, but no longer.

I have a pretty big caffeine addiction but it's not because I sleep bad, I just love it. I started to drink coffee because it seemed healthier than red bull.

But with all the kids and a like drinking red bull all the time, we should se a lot of suspicious deaths if this was so dangerous, shouldn't we?

Caffeine is dangerous in a way. It's very addictive and lethal at relatively low doses. Not everyone experiences lethal effects at the same dose: "The LD50 of caffeine in humans is dependent on individual sensitivity, but is estimated to be about 150 to 200 milligrams per kilogram of body mass or roughly 80 to 100 cups of coffee for an average adult." Maybe this teen had some condition before hand/was taking other medicines? I guess if they were very thin that might do it?

> relatively low doses

> roughly 80 to 100 cups of coffee

You and I have different definitions of "low dose".

It could easily be delivered through a number of high-caffeine energy drinks (5-Hour Energy contains 200-230mg of caffeine [1]; a few whole cups worth of it could easily kill someone) or caffeine pills. When insufflated, pure caffeine can easily lead to overdose/death. While a couple cups of coffee might not do it, caffeine is delivered in a variety of forms.

[1] https://www.caffeineinformer.com/the-caffeine-database

That would also be well over the volume of pure water that can also cause death by water intoxication - see the "Hold your Wee for a Wii" incident.

Assuming the caffeine was delivered in liquid form (in coffee, energy drinks, sodas, etc). It would be fairly easy to exceed lethal dosage via caffeine in tablets, powder, or capsule form.

> It's very addictive

Some people do indeed get headaches, etc. if they don't get their morning fix. On the other hand, people like myself like some morning tea or coffee but can skip it as needed or get it when we arrive in the office.

I haven't read research to indicate how the population splits between those extremes.

Uh, yes and no. I have gone on and off caffeine for years. The withdrawal is mild--nothing a couple of ibuprofen and staying hydrated can't mitigate. It's not heroin!

After say 48-72 hours, you're caffeine free.

I drink coffee to stay sharp while coding, but like I said, I have quit it for long periods of time due to sleep issues and things. I now mostly just drink decaf for coding (note: decaf is not "non-caf").

I should add, I've never been addicted to anything ever--for whatever reason, I can just walk away and never want <fill in the blank> again. For others, psychological addiction can be tough to get over.

I'm heavily hooked to cigarettes, however, walking away from caffeine was absolutely trivial. I was told to stop due to panic attacks, so I was lucky having sick leave to deal with the initial abstinence.

Long term, zero caffeine is like being on caffeine all the time. It's worth ditching.

I'm glad someone can relate. I feel like how much coffee I drink is making my panic attacks worse. Cigarettes surely don't help.

TFA says he was neither thin nor had a known preexisting condition. My guess is it's just one of the freak things that happen sometimes. This was a very small amount of caffeine compared to what my average coworker drinks.

According to the article, this young man weighed 90 kilograms. Not exactly tiny.

Because you can now buy caffeine in pure liquid and powder form whereas for most of human history, that kind of concentration was not possible.

A bit of an aside: I cut caffeine out 8 months ago except for the occasional caffeinated coffee or coke. Felt great after the first week, even, and haven't looked back since.

I take regular breaks from caffeine and my quality of life goes way up, but my quality of work goes way down. :) Wish I could live without the stuff

If your quality of life goes way up it then the overall quality of your work will increase in the long to very long term.

As long as my work doesn't involve coding. Caffeine makes doing tedious things for long periods of time much more engaging.

I genuinely don't follow: "Cut caffeine ... except for the occasional caffeinated coffee" -- what does that leave? Do you mean you just reduced your coffee intake?

adenadel is correct. I am a coffee snob and will pour over or brew espresso every day. However, I switched out caffeinated coffee for decaf for all of the 6 months and have recently been tempted by some new beans. I'm really into trying different origins and roasters, which makes doing decaf hard over time.

I probably do < 1 caffeinated beverage per week on average, and never drip coffee due to the caffeine content. Lately I've been having a bit more as I experiment re-introducing it with L-Theanine.

The biggest reason I cut it out initially is a type of heartburn that I couldn't explain the source of. It vanished once I cut caffeine.

Cool. Yeah-- I've had various stints with going with decaf instead, but (somewhat like you) the wider selection always pulled me back.

The OP probably went from 1-3 cups a day to a single beverage once every couple weeks.

I doubt it was purely caffeine. The last time I consumed a small energy drink, I had heart palpitations. Pure caffeine (from No-Doze) doesn't give me heart palpitations; but energy drinks contain more than just caffeine.

The LD50 of caffeine in humans is dependent on individual sensitivity, but is estimated to be about 150 to 200 milligrams per kilogram of body mass or roughly 80 to 100 cups of coffee for an average adult.

"may have consumed about 470mg of caffeine in just under two hours"

I find it hard to believe that caused a problem for a 200lb person. I'm 150 and drink more than that every morning and have for years (2/3rds or a full pot, big cup, it's gone pretty quickly--like 1.5 hours). I also pretty regularly will drink 3 or 4 (150mg/ea) venti lattes in a couple of hours. As far as I can tell, I'm still alive.

https://en.wikipedia.org/wiki/Drug_tolerance

Tolerance generally does not affect the lethality of a drug.

Hospice patients on morphine would strongly disagree.

http://www.medscape.com/viewarticle/562216_3

> Pharmacokinetic changes occur, for example, if the drug up-regulates the activity of a metabolic process that represents a major pathway for its elimination from the body. Enzyme induction results in a gradual reduction in plasma drug concentration while the daily opioid dose remains unchanged.

This isn't even the kind of claim that can be tested scientifically--there are too many different kinds of drugs. And I can think of many drugs where tolerance does affect lethality (opiates, alcohol). Where are you getting this information from?

That's not entirely accurate in general. If the tolerance is the result of improved metablosim (as in alcoholism), then it could lead to decreased lethality.

https://psychonautwiki.org/wiki/Caffeine#Toxicity_and_harm_p...

Assuming this kid is ~60kg (not fully grown) that's still at least 9000mg+ for an LD50.

However, this seems like a huge number. I'm not much of a caffiene-user but know I get heart palpitations around 500mg and they sure feel like if I drank the same amount again I'd have serious problems.

You're assuming the kid wasn't dehydrated as well.

I never drank caffeine until college, got hooked on it for the last 5 years or so, just stopped using it last week. I feel great now. If you don't drink coffee for pleasure and only for the caffeine it's worth trying life without it.

You have to stop the caffeine intake for 2 weeks every 2 months, otherwise the adenosine receptors adapt and you won't feel the same effects.

I find it's worse than that. I still get the nervousness and eyelid twitches, but not the sharper focus. That's when I know it's time to cut back.

Is everybody really drinking coffee to become super workers? I think it tastes great and is nice to sip. It provides a distraction from my screen. I don't even know if I'd notice its decaf.

For me, it's both. Some days, I've been up all night with a sick kid, and I need coffee to keep my head off my keyboard. But I also enjoy the flavor and drink black coffee because I think it's delicious. My comment is really about the symptoms of caffeine addiction, tolerance, and withdrawal. If I drink more than three cups a day, I get eyelid twitches. If I drink fewer than two, I get a crushing headache. If I had only one of work and kids, I'd probably drink less coffee because that way I'd be able to enjoy it more by choice and less because I have to feed my habit.

I can't tell if this is sarcasm or not, but I would go so far as to say that a vast majority of people have coffee (or another source of caffeine) in an attempt to boost their productivity.

It wasn't sarcasm. I was surprised that most of the coffee drinkers here were commenting about it in regards to productivity. I actually thought most people were like me and drink it for the flavor, provided distraction, therapeutic feelings it invokes, etc, along with productivity.

In fact, sitting my back yard and sipping a nice, warm cup of coffee is just about one of my favorites Saturday rituals, and I have no plans to be productive that day. Coffee is just... pleasant!

Interesting how this story suddenly disappeared from the front page of hacker news.

This is not passing the smell test. I, and many familiars, have greatly exceeded this kids intake. There has to be something else going on here. The media FUD surrounding this is deafening.

I partially agree, seems a bit fishy but then again people OD at various levels. Seems like I read that someone had a 0.9% BAC which would be 2x the amount that would kill most people.

A lot of things can be triggers for undiagnosed heart conditions.

It turned out that "running to the river carrying a boat on your head" triggered my then 18-year-old brother's undiagnosed heart condition.

The fact that he was otherwise fit as an ox and his friend knew how to do CPR, meant that after a multiple bypass op he was back riding a bike in a few weeks, and has since turned out fine as a patent lawyer ... oh wait ....

He had 3 caffeinated drinks. Obviously, he had a heart condition, but I'd guess this isn't the first time he'd had that much caffeine in his body. Kid just got dealt a shit hand.

"The media FUD surrounding this is deafening."

I wonder how to follow the money on this. It could just be Puritanism.

"We're not trying to speak out totally against caffeine," Mr Watts said. "We believe people need to pay attention to their caffeine intake and how they do it, just as they do with alcohol or cigarettes."

What.

What's not to understand?

For starters, alcohol and tobacco are massive killers, two of the biggest known, responsible for millions of deaths worldwide each year (and hundreds of thousands in the U.S. alone).

Mentioning coffee alongside these other two is patently ridiculous.

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-co...

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast...

Yes! I can't get over how people can think "smoking bad" but "alcohol ok". Alcohol is a fuel. Do you drink gasoline?

"But muh beers..."

A doctor implying that they're not speaking out "totally" against cigarettes.

He "wasn't totally against" caffeine, not cigarettes.

people need to pay attention to their caffeine intake and how they do it, just as they do with alcohol or cigarettes

Note "as they do" as opposed to "as I recommend to do" or anything of this kind.

edit:

And have a downvote for your know-it-better tell-everyone-what-to-do-with-their-lives attitude. It's not that much effective and creates lots of ill will. Because I think I know what was your problem with this quote and what you would prefer it to be instead.

Do you, now? I'm a social smoker. I was just surprised at the quote.

I apologize for jumping at you. Your posts sounded like common faux outrage to me.

Have an upvote for being in the 0.001% of HN participants with the ability to use the words "I apologize". :)

I'm assuming the doctor in that quote misspoke, though.

Mayo Clinic recommended you do not exceed 400 - 600mg of caffeine a day. It's a drug like anything else.

Can you OD on cigs? Like smoke 24 packs in a row and die?

You'd pass out long before from the carbon monoxide alone. Not really a great RoA for overdosing.

And you'll get a very bad headache if you really overdo it. The headache is awful, not even a night of sleep can resolve it (caffeine does). Probably related to the carbon monoxide.

That sounds fun

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