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July 30, 2014

Caffeine powder packs more than an energy punch

An Ohio teen mysteriously dies just days away from his high school graduation. One month later, the coroner finds the cause of death: caffeine overdose. He had more than 70 micrograms of caffeine per milliliter of blood in his system, 23 times the amount of a typical coffee or soda drinker. In his room, the teen's mom found bags of white powder later identified as caffeine powder. This caffeine powder was bought online and is totally legal.

Caffeine is one of the most commonly used stimulants in the United States. Caffeine is found in tea, coffee, chocolate, many soft drinks and energy drinks, and over-the-counter medications. Known for giving the user a burst of energy and increasing alertness, people often use it for a pre-workout boost or to stay awake and study (like Jessie Spano from 90's sitcom Saved by the Bell...you can find a clip of her character's dramatic caffeine-induced breakdown on youtube). Partygoers take it to combat the downer effects of alcohol and marijuana. Caffeine powder is marketed as an alternative to coffee or soft drinks and much cheaper than buying the expensive energy drinks — one could mix it in shakes, drinks, or even food.

Like other drugs, caffeine has a number of side effects. Small amounts of caffeine can cause headaches, jitteriness, and sleep disturbances. Higher amounts can cause very high heart rates or an abnormal heart rhythms, agitation, and seizures. Regular caffeine consumption leads to physical dependence, which manifests as withdrawal symptoms when the user abruptly stops using caffeine.

Caffeine powder, like the kind found in the Ohio teen's room, is much more potent than most caffeinated products (see table below). Its small serving size of 1/16 of a teaspoon requires mini-measuring spoons and a scale to measure. This 1/16 of a teaspoon can contain about 200 milligrams of caffeine, roughly the equivalent found in two large cups of coffee. Experts agree that you should avoid having more than 600 milligrams of caffeine in one day; 5,000-10,000 milligrams (5-10 grams) of caffeine is considered the lethal amount in an adult. Even less could be lethal in a caffeine-naïve teen. That looks like a large number, but just one teaspoon of caffeine powder may contain as much as 3,200 milligrams of caffeine (equal to 25 cups of coffee). Simply mixing two regular spoonfuls of the powder into a drink is the same as drinking more than 70 Red Bulls at once, which could kill you.

This is not the first time in recent history that caffeine has been in the news for negative effects. In 2013, the United States Food and Drug Administration (FDA) investigated 13 deaths and 33 hospitalizations related to 5-hour Energy products. In 2010, the FDA forced manufacturers of alcoholic caffeinated beverages (like Four Loko) to cease production of those drinks due to concern that caffeine masked signs of intoxication in users leading to increased binge drinking (and more serious health consequences).

Caffeine powder is sold as a dietary supplement, so it's not subject to the same federal regulations as certain caffeinated foods, beverages, or medications. The FDA said it is collecting additional information about the powered products and will consider taking regulatory action as appropriate.

In the meantime, my advice is to avoid caffeine powder. It's nearly impossible to accurately measure the appropriate serving size and it extremely easy to overdose. If you believe you are having an adverse event related to caffeine, stop using it and seek immediate medical care or advice. For questions regarding caffeine or any other substance, contact your local Poison Center at 1-800-222-1222.

Caffeine content in common products

Product — Serving size — Caffeine content

Starbucks coffee — 16 oz (Grande) — 330 mg

Starbucks coffee — 20 oz (Venti) — 415 mg

Coffee — 8 oz — 135 mg

Diet Coke — 12 oz — 45 mg

Mountain Dew — 12 oz — 54 mg

Lipton Tea — 8 oz — 35-40 mg

Excedrin — 1 tab — 65 mg

Red Bull — 8.4 oz — 80 mg

5-hour Energy — 1.9 oz — 208 mg

No Doz — 1 capsule — 200 mg

Zantrex-3 (weight loss supplement) — 2 caps — 300 mg

Caffeine powder — 1/16 tsp — 200 mg