What you need to know about the Caffeine Overdose in South Carolina

What you need to know about the Caffeine Overdose in South Carolina

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Excessive caffeine led to the death of a 16-year old in South Carolina named Davis Allen Cripe. As a biochemist studying energy drinks, I share my understanding of what happened and what caffeine research tells us about caffeine and heart issues.

Contents (click to jump):

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Caffeine Consumed from All Sources

According to the Associated Press, the Richland County Coroner Gary Watts said the teen consumed a large Mountain Dew, a McDonald’s latte, and an energy drink two hours before he began experiencing an arrhythmia.

According to the Caffeine Informer database, a 12 oz can of Mountain Dew has only 54 mg caffeine, so a large 20-ounce bottle would have 90 milligrams of caffeine. A McDonalds Latte has 142 milligrams of caffeine.

It’s not indicated which energy drink the teen consumed, but if we look at the caffeine contents of the top three bestselling brands, the caffeine content may have been 80 milligrams with a Red Bull or 240 milligrams from a Rockstar.

If you’re under 18 years old, you should have no more than 100 milligrams of caffeine per day, according to the American Academy of Pediatrics.

Regardless of which energy drink he consumed, the teen was already over the 100-milligram mark when he drank the McDonalds latte. The (undisclosed) energy drink he consumed afterward is not irrelevant, but it’s not the full story.

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Where The News Outlets are Getting it Right

The coroner said it perfectly in an article from AJC.com,

“The purpose here today is not to slam Mountain Dew, not to slam cafe lattes or energy drinks. But what we want to do is to make people understand that these drinks — this amount of caffeine, how it’s ingested, can have dire consequences. And that’s what happened in this case,” Watts said in a news conference.”

In the Associated Press article,

“Cripe’s father says he was a good son who would never touch alcohol or drugs and he hopes the teen’s death will save other lives by showing the dangers of excessive caffeine.”

Not “the dangers of energy drinks” but “the dangers of caffeine”. I’ve been harping on this point for over 10 years now. Again, the point is not whether energy drinks are dangerous (some of them are, some them aren’t!), it’s the whole picture that matters.

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The Study I CAN’T STAND That News Outlets Keep Citing

In the CNN coverage of this teen’s caffeine overdose, they cite a journal article that I simply can’t stand. The CNN article states, “A 2014 study found an estimated 73% of children consume some kind of caffeine each day.” This 2014 study is “Trends in Caffeine Intake Among US Children and Adolescents” published in the journal Pediatrics.

This study reviewed how much caffeine kids were consuming from each source and how that distribution changed from 1999 through 2010. One of my biggest issues with this article is that energy drinks did not exist until around 2003. So news outlets keep interpreting these findings as “energy drink consumption is on the rise in teens” without acknowledging that it’s “on the rise” from 0.

My other huge problem with this study is that it’s misleading. This study indicates that neither energy drinks nor coffee is the primary source of caffeine for kids, but that message always gets lost because of statements within this study like, “…coffee and energy drinks represent a greater proportion of caffeine intake as soda intake has declined.” This increase in energy drink consumption is taken out of context and energy drinks become the enemy without addressing the bigger problem with caffeine consumption in kids.

Quoting from the Pediatrics study,

“Approximately 73% of children consumed caffeine on a given day. Soda accounted for the majority of caffeine intake, but this contribution declined from 62% to 38% (P < .001). Coffee accounted for 10% of caffeine intake in 1999–2000 but increased to nearly 24% of intake in 2009–2010 (P < .001). Energy drinks did not exist in 1999–2000 but increased to nearly 6% of caffeine intake in 2009–2010.”

So energy drinks account for only 6% of the caffeine kids are consuming. Most kids get caffeine from soda. This is corroborated by a robust, well-designed study in Food and Chemical Toxicology, involving over 40,000 participants. That study, “Beverage Caffeine Intakes in the US” found,

“The greatest proportion of caffeinated beverage consumers consuming energy drinks were teenagers or young adults; however only 5-7% of total caffeine intake was attributable to energy drinks in these age groups.”

More importantly, even though kids are getting caffeine from different sources, kids are not consuming more caffeine today than they were in 1999. Even the Pediatrics study itself cites,

“Mean caffeine intake has not increased among children and adolescents in recent years.”

This doesn’t mean that energy drinks aren’t a problem in teens, it means that awareness of overall caffeine consumption from all sources needs to be hammered into these kids’ brains. In other words, if there’s a kid out there anywhere who thinks they can avoid all energy drinks but consume as many Mountain Dews, McDonald’s Caffe Lattes or Starbucks Grande coffees in one day as they want, we have failed.

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Caffeine and Arrhythmias and the American Heart Association 2017 Study

During an arrhythmia, or abnormal heart rhythm, the heart may not be able to pump enough blood to the body, and lack of blood flow affects the brain, heart and other organs. In cardiology, the QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart’s electrical cycle. QTc prolongation is a recognized marker of increased risk for fatal arrhythmias. Prolongation of the QT/QTc interval by more than 60 ms from baseline or a value >500 ms is a marker for life‐threatening arrhythmias.

Are energy drinks worse for heart arrhythmia than caffeine from coffee? Caffeine Informer’s research compilation suggests no. One study using 320** milligrams of caffeine says yes, but this study has severe limitations.

**If you’re a healthy adult, you can consume 200 milligrams in one sitting, and up to 400 milligrams of caffeine per day, according to the Scientific Opinion on the safety of caffeine from the EFSA

In the 2017 study, “Randomized Controlled Trial of High‐Volume Energy Drink Versus Caffeine Consumption on ECG and Hemodynamic Parameters”, participants consumed either a 1‐time 32‐ounce (946 mL) dose of a commercially available energy drink or a matching 32‐ounce (946 mL) control drink:

Contents of Energy Drink and Caffeinated Control
Why is hour 2 so different?

The participants who got the energy drink experienced significant QTc prolongation of ≈10 ms [>60 ms is a marker for life-threatening arrhythmias] 2 hours after high‐volume energy drink consumption.

NOTE – this study used only 18 people in their mid-twenties. There were no significant differences at any point other than the Hour-2 time point. Heart rate, diastolic BP, central systolic BP, and central diastolic BP showed no evidence of a difference between groups at any time point.

“Our results should be interpreted with caution due to several limitations. Importantly, our results only appear to be significant relative to the caffeine group, and the change from baseline post energy drinks is not alarming. Of note, the risk of arrhythmia may be negligible because the QTc difference is transient.”

Another study comparing low‐ and moderate‐dose energy drinks, coffee, and water, found no changes in the QTc interval. So maybe the key is the lower dose of caffeine. It would also be nice to rule out some of the ingredients in the energy drink used in the study. Taurine is antiarrhythmic – taurine protects the heart.

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Bottom Line

Every child should know how much caffeine they can have in one day and should be warned of the consequences of too much caffeine like they are warned about the consequences of too much alcohol. Every child should know how to read a label and find out how much caffeine is in something they are about to consume.

We aren’t told which energy drink the teen consumed, so it’s unfair to speculate or to attribute his death on any caffeine-ingredient interactions. Mountain Dew’s Kickstart looks like a regular soda. Some energy drinks look like coffee beverages or herbal teas. Some coffees have more caffeine than a Red Bull. Some pre-workout supplements have more caffeine than an adult should consume in one day. The cause of death for Davis Allen Cripe was too much caffeine, so we need to emphasize the danger of caffeine (from all sources) with kids and teens.

Starbucks was not on every street corner in the 90’s, so parents these days have to realize that highly caffeinated beverages are readily available even if their child avoids the stereotypical energy drink. Furthermore, if a child is struggling with staying awake, they should feel comfortable talking to their parents about healthy alternatives. When all energy drinks are cast in the same light, these conversations don’t happen, and energy drink consumption continues in secret.

There are many safer, cleaner caffeinated products (“energy drinks in disguise”) nowadays so this is a conversation every parent should be having with their child. Hopefully, these are the conversations that can save more lives.

If anyone can put me in touch with the school Davis Allen Cripe attended, I would like to help them through this tough loss. I believe I could start the dialog, and help his classmates understand how to avoid the dangers of caffeine and how to find healthier alternatives.

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