Suicide by ingestion of caffeine

BACKGROUND: Mr K, aged 48, was found sweating by his partner at home at 11.50 pm. He claimed to have attempted suicide. She immediately called the Emergency Unit to ask for support. At the phone, the physician on duty indicated her to give a pill of Lysanxia (prazepam) to decrease the level of stress of the victim. However, the clinical situation worsened and he was taken to the hospital at 1.00 am. At his arrival at 1.28 am he was in cardiac arrest. Despite intensive resuscitation manoeuvres, death was pronounced at 2.30 am. At home, an empty plastic bag with a 100 g caffeine label was found. The drug was bought via Internet 6 months earlier. External body examination and autopsy revealed the lack of any traumatic injury. FINDINGS: During examination, the pathologist collected peripheral blood (femoral blood). This specimen was tested for ethanol, volatiles, pharmaceuticals and drugs of abuse, using head space GC/FID and GC/MS, ELISA, LC-DAD, GC/MS and LC/MS/MS. Ethanol tested negative in blood. Using a dedicated LC/MS/MS procedure, caffeine was identified at 401 mg/l, which can correspond to a fatal concentration. Nordiazepam, sertraline and fluoxetine, the prescribed medications of the victim, were identified at therapeutic concentrations, 188, 31, and 48 ng/ml, respectively. Amiodarone was also identified at high concentration (4200 ng/ml), part of the medical assistance of the rescue team. CONCLUSION: The manner of death was considered as acute intoxication with caffeine.