Caffeine toxicity: a case of child abuse by drug ingestion

The case of a 14-month-old child who died of caffeine toxicity is presented. The evidence for prolonged toxicity associated with inappropriate delay in the seeking of medical care and the presence of various recent and healing injuries are diagnostic of child abuse. Fatal caffeine toxicity and child abuse by drug/substance administration are uncommonly reported. Relevant medical literature is reviewed.     

Rapid analysis of caffeine in "smart drugs" and "energy drinks" by microemulsion electrokinetic chromatography (MEEKC)

A novel method based on microemulsion electrokinetic chromatography (MEEKC) with diode array detection (DAD) for rapid determination of caffeine in commercial and clandestine stimulants, known as "energy drinks" and "smart drugs", is described. Separations were carried out in 50 cm × 50 μm (ID) uncoated fused silica capillaries. The optimized buffer electrolyte was composed of 8.85 mM sodium tetraborate pH 9.5, SDS 3.3% (w/v), n-hexane 1.5% (v/v) and 1-butanol 6.6% (v/v). Separations were performed at a voltage of 20 kV. Sample injection conditions were 0.5 psi, 3 s. Diprofilline was used as internal standard. The determination of the analytes was based on the UV signal recorded at 275 nm, corresponding to the maximum wavelength of absorbance of caffeine, whereas peak identification and purity check was performed on the basis of the acquisition of UV radiation between 200 and 400 nm wavelengths. Under the described conditions, the separation of the compounds was achieved in 6 min without any interference from the matrix. Linearity was assessed within a caffeine concentration range from 5 to 100 μg/mL. The intra-day and inter-day precision values were below 0.37% for migration times and below 9.86% for peak areas. The present MEEKC method was successfully applied to the direct determination of caffeine in smart drugs and energy drinks.     

Acallosal brain in sudden infant death syndrome (SIDS).

A definitive explanation of "crib" or "cot" death remains unknown. An unusual incidental autopsy finding of agenesis of the corpus callosum in a case presenting as "near miss" sudden infant death syndrome (SIDS) is discussed. Hitherto, only a single case associated with SIDS has been reported in the literature. The condition may be easily missed outside the interest in neuropathology.     

Pulmonary artery perforations as typical complication in the use of Swan-Ganz catheters

Two cases of pulmonary artery perforation are reported in association with the use of the Swan-Ganz catheter. A 71- and a 95-year-old woman were monitored by a flow-directed catheter pre- and intraoperatively. Both of them died. After taking other cases in the literature into consideration, this severe complication can be classified as "typical" for this examination technique. Possible means of prevention, diagnosis, and treatment of these complications are discussed. A review of incidence and genesis is given.     

140例海洛因毒品案鉴定结果分析

１４０例海洛因毒品案鉴定结果分析张润生（上海市刑事科学技术研究所;上海２０００８３）ＡＮＡＬＹＳＩＳＯＦ１４０ＣＡＳＥＳＯＦＨＥＲＯＩＮ￥ＺｈａｎｇＲｕｎｓｈｅｎｇ（ＳｈａｎｇｈａｉＩｎｓｔｉｔｕｔｅｏｆＦｏｒｅｎｓｉｃＳｃｉｅｎｃｅｓ;Ｓｈａｎｇｈ...     

Fatality of 33‐Year‐Old Man Involving Kratom Toxicity

Kratom is an herbal product commonly used for its effects which are similar to opioids and stimulants. Few studies demonstrate the dangers and lethality of Kratom, and most fatalities from Kratom involve other abused substances. In the current case report, a 33‐year‐old white man with a known history of opioid abuse and mental illnesses was found unresponsive in his basement with no obvious signs of trauma. After resuscitative efforts, he was pronounced dead and taken for autopsy evaluation. Blood from the inferior vena cava was analyzed for common abused substances. The laboratory toxicology work‐up revealed positive findings of caffeine, cotinine, and naloxone with low levels of Δ‐9 tetrahydrocannabinol. However, a marked level of mitragynine at 1.9 mg/L was observed, the highest reported to date. Given the facts and evidence, the medical examiner certified the cause of death as “mitragynine toxicity” and the manner of death was classified as an “accident.”     

Suicide by inhalation of carbon monoxide in a residential fire

Fire deaths are usually accidental, but atypical cases of homicide or suicide have been described. In suicide by fire, the only method reported by several authors consists of self-immolation. We present here the unusual case of an adult female who committed suicide by waiting in the living room after setting fire to her bedroom. The autopsy revealed smoke inhalation and the toxicological analysis revealed carboxyhemoglobin levels of 67%. Very few cases of suicide by fire not of the self-immolation type have been reported, and all have been anecdotal. A review of the literature is presented and a new term, "suicide by inhalation of carbon monoxide in a fire," is proposed for such cases.     

Quantitative analysis of mitragynine, codeine, caffeine, chlorpheniramine and phenylephrine in a kratom (Mitragyna speciosa Korth.) cocktail using high-performance liquid chromatography

A simple HPLC technique for determining mitragynine, codeine, caffeine, chlorpheniramine and phenylephrine in 'kratom cocktail' was developed. The analytical method for mitragynine, codeine and caffeine used an Eclipse XDB-C8 column. A Lichrospher CN column was using for analysing chlorpheniramine and phenylephrine. The correlation coefficient of each standard was between 0.9957 and 0.9993. The precision of the methods were between 0.700 and 7.108% RSD. The concentration of mitragynine, codeine, caffeine, chlorpheniramine and phenylephrine in 'kratom cocktail' was 90.021, 234.174, 73.986, 7.053 and 1.486 mg/L, respectively.     

Caffeine fatalities--four case reports

Four cases of fatal intoxications with caffeine are described. Caffeine is widely available in beverages and in different OTC-products, in many of them in combinations with other drugs like ephedrine. Caffeine is not as harmless as one might believe. An overdose of caffeine alone, intentional or not, might be deadly. It seems to be warranted to include caffeine in the drug-screening of forensic autopsy cases. It is not motivated from a medical point of view to sell pure caffeine over the counter.     

A multi-chemical death involving caffeine, nicotine and malathion

Death of a 21-year-old man who was found in a shower stall in his residence is described in the study. At the scene, a 3/4 filled blue glass bottle labeled "Black Leaf 40" (an insecticide containing nicotine), a white plastic pitcher 1/3 full of thick white fluid, a beer mug 1/4 full of thick white fluid, and an empty carton of milk were found. In addition, a can of malathion and an empty bottle labeled caffeine also were found in the vicinity. Autopsy was performed, and the gross examinations of organs revealed no specific findings to account for the death. However, marked congestion in lung, liver, spleen and kidney were noted at microscopic level. Autolytic degenerative changes were also observed in stomach, small bowel and colon. Toxicological analyses of the autopsy samples (blood, urine, liver and gastric contents) revealed the presence of caffeine and nicotine in each sample. Malathion was found to be present only in gastric content. Caffeine and nicotine were analyzed by utilizing gas liquid chromatography-nitrogen phosphorus detector, while malathion was by gas liquid chromatography-flame photometric detector. Analyses of the fluids from the bottle, pitcher and mug disclosed the presence of nicotine in the concentrations of 17.8%, 3.7% and 5.7% (w/w), respectively. The fluids from the pitcher and mug also contained 2.7-2.9% malathion. Results conclude the death was associated with caffeine, nicotine and malathion.     

Nail analysis for the assessment of caffeine abuse in Northwest China: A population-based study

Caffeine is the most widely consumed psychoactive agent worldwide and has the potential for abuse, but studies monitoring caffeine abuse in China are scarce. This study aims to estimate the prevalence of caffeine abuse in northwest China and investigate the correlation between caffeine and other drugs in hair and nails using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Fingernail clippings were collected from 376 participants in northwest China to detect caffeine and 13 other illicit psychoactive drugs and their metabolites. Paired hair and nail samples were collected from 39 participants to investigate the correlation between caffeine and other drugs in hair and nails. The samples were decontaminated, pulverized, and extracted by a high-throughput nail sample preparation method and analyzed by UPLC-MS/MS. The results showed a risk of caffeine abuse in northwest China, with concentrations ranging from 0.43 to 10.6 ng/mg for healthy volunteers, 0.49–246 ng/mg for caffeine abusers, and 0.25–363 ng/mg for drug addicts in community rehabilitation centers. Caffeine was detected together with other illicit psychoactive drugs and their metabolites. Furthermore, positive detection correlations were found between hair and nail samples. This study provides a current perspective on caffeine abuse in northwest China and demonstrates the practical use of UPLC-MS/MS for the simultaneous detection of caffeine and 13 illicit psychoactive drugs and their metabolites in hair and nails. The results highlight the potential of nails as a supplementary matrix when hair samples are unavailable and emphasize the need for handling caffeine carefully given its potential for abuse.     

Wrapped to death. Unusual autoerotic death

Despite the large population of New Orleans, including many homosexual and transsexuals, there have been relatively few cases of autoerotic deaths. The case reported here is an interesting one as it includes a bizarre form of autoerotic behavior from the standpoint of the method used. There have been no deaths reported in the literature in which the victim died as a result of jeopardizing himself by enclosing his body into plastic with an airway out of his "cocoon" in the form of a snorkel tube. He was engaged in masturbation when he apparently lost his mouth piece or airway. He attempted to use a knife to cut himself out.     

Wanted and Unwanted Sexual Experiences and Family Dysfunction During Adolescence

The goal of this study was to examine the relationship between family dysfunction and wanted, unwanted, and illegal sexual experiences that occurred during childhood and adolescence. Three hundred fifty-three subjects from a sexual abuse clinic, a family practice clinic, and a family planning clinic anonymously completed a survey on childhood sexual experiences and physical violence, family substance abuse, violence toward others, and family quality. Overall, 50% had had unwanted (USE) and wanted sexual experiences (WSE) before they turned 18. Subjects in the sexual abuse clinic had the highest percentage (90%) of unwanted or illegal sexual experiences, followed by the family planning subjects (40%) and the family practice subjects (30%). Both USE and WSE were related to family dysfunction scores, even when they were controlled for demographic influences. Family dysfunction scores were highest for those who reported USE and legal WSE and were lowest for those who reported no USE or WSE.     

海洛因、咖啡因的FTIR检验及谱图解释

目的提高用红外光谱法鉴定海洛因、咖啡因纯品、混合物伪品的水平。方法用红外光谱法有针对性地选择特征峰 ,探明海洛因、咖啡因红外光谱与结构的关系。结果获得海洛因、咖啡因的特征峰。结论该方法克服了鉴定中的盲目性。     

Impurity profiling of ecstasy tablets seized in Hong Kong by gas chromatography-mass spectrometry

In Hong Kong, ecstasy tablets are more commonly known as "Fing Tau Yuen", literally meaning "Shake Head Pills". The tablets contain mainly amphetamine-type stimulants (ATS) including 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MA) and/or ketamine. Adulterant such as caffeine was also detected in the tablets. This paper reports a study on the impurity profiles of ecstasy tablets from 89 seizures in Hong Kong from 2002 to early 2004. Tablet samples were extracted by diethyl ether under alkaline condition and then analyzed by gas GC-MS. The chromatograms obtained were compared. A total of 19 identified impurities were selected as markers for impurity profiling. They are different precursors, intermediates and by-products. The data matrices were examined by hierarchical cluster analysis (HCA), and then the ecstasy tablets were classified into different groups. Cluster analysis of ecstasy tablets is shown to be capable of providing intelligence on clandestine laboratory networks.     

Isolation, extractive concentration, and determination of caffeine in the studies of blood plasma

The optimal conditions for the isolation of caffeine from human blood by means of acetone extraction are described with special reference to the peculiarities of extraction from aqueous solutions. The possibility of concentration and purification of caffeine from blood plasma using acetone and aceton-chlorophorm mixture (2:8) as the solvents is illustrated. In addition, purification by silica-gel thin layer chromatography is discussed. Thin layer chromatography, UV-spectrophotometry, and high performance liquid chromatography are considered as potential methods for the identification and quantitative determination of caffeine.     

Toxicological findings in a multi-drug death involving propoxyphene, caffeine, phenacetin, acetaminophen and salicylate

The toxicological findings of a multi-drug related fatal poisoning are described here. A 35-year-old Caucasian male found dead on the kitchen floor was a known user of abused drugs and had been taking aspirin alone or in combination with phenacetin and caffeine for the relief of joint pains. The gross examination of the organs at autopsy revealed slight grooving of the uncus and various stages of necrosis in the renal papillae. Histological examination confirmed the gross appearance of pulmonary congestion and edema, cerebral edema and interstitial nephritis of the tubules. Toxicological evaluation of the blood and urine samples disclosed the presence of propoxyphene (51 and 250 mg/l), salicylate (185 and 2750 mg/l), caffeine (16 and 37 mg/l), and phenacetin (9.6 and 20 mg/l). Furthermore, acetaminophen also was present in the plasma (54 mg/l) and urine. A gas liquid chromatographic method for simultaneous analysis of phenacetin and caffeine utilizing a nitrogen phosphorus detector was proposed.     

Fatty degeneration in renal tubule epithelium in accidental hypothermia victims

The diagnosis "death due to hypothermia" is mainly based on circumstances and gross autopsy findings like frost erythema and gastric erosions. Up to now, there are no reliable histologic criteria available to confirm the diagnosis "death due to hypothermia." However, fatty changes of organs have been reported already in the literature as a histological finding contributing to the diagnosis "death due to hypothermia." To evaluate these reports, cases with well-documented hypothermia (study-group; n=83), cases with other causes of death (control-group; n=25) and additionally also seven cases with a past medical history of diabetes mellitus were investigated. Renal tissue autopsy samples were taken from both the left and the right kidney and investigated for signs of fatty degeneration within the renal tubule epithelium. The results were compared with regard to macroscopic signs of hypothermia (Wischnewski-ulcers, erythema), as reported in the autopsy protocols. The results lead to the conclusion, that fatty degeneration is a very reliable histologic diagnostic criterium in cases of hypothermia, comparable to the significance of Wischnewski-ulcers.