Did a 16 year old Really Die from a Caffeine Overdose?

Sixteen year old Davis Cripe started having heart rhythm problems and collapsed last month at his South Carolina high school, passing away. His autopsy was released today Doctors said they had found no previously existing heart problem. They believe his death was from a caffeine overdose which caused a heart arrhythmia (irregular heartbeat.) Reports say that in the two hours before his collapse, the teen drank a large diet mountain dew, a McDonald's latte and an energy drink.

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While I'd of course think that too much of anything could cause of problem, but I'd not heard of a caffeine overdose before. I like my coffee, hard to even imagine giving it up, particularly in the morning. So this made me curious to look into what has been seen to be safe consumption levels.

How Much Caffeine is Too Much?

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Most places I've seen set the safe daily limits of caffeine to be 400mg per day for most adults. Obviously there is some fluctuation between what each of us can handle due to factors such as weight, existing health issues, etc. To get a little better perspective, let's see how much caffeine is in our drinks.

Coffee and Tea

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An 8-oz cup of coffee has 95 milligrams of caffeine. Espresso shots typically each deliver between 130 - 150mg. This would make up to four cups within the general safe range. Admittedly my personal coffee cup is larger than eight ounces and frequently ordering a Venti size at Starbucks (20 ounces.)

Since coffee shops usually serve caffeinated teas as well, I figured it was worth including that most teas have between 15 - 95mg averaging around a 16 oz drink. The range varies between the brand (Arizona, Starbucks, Lipton, etc) as well as type (Green, Black, Oolong, White, etc.) For those of you that prefer to make your own tea from leaves, the common amounts per type are:

Black Tea: 23 - 110 mg
Oolong Tea: 12 - 55 mg
Green Tea: 8 - 36 mg
White Tea: 6 – 25 mg
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What I found interesting with teas is that if you wanted to reduce the caffeine delivered, you can either:

Steep your tea in cooler water for a shorter period of time or
Steep your tea normally for 45 seconds, discard of that, and then brew it like you normally would. This makes a difference because the vast majority of caffeine is released in the first 30 seconds or so.

I've not been able to find reports of people dying from a caffeine overdose purely from coffee or tea.

Soda

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I found it interesting that the FDA has an official limit of caffeine in a 12 ounce "cola and pepper soft drink" set at 71 milligrams. I tried to get the following levels adjusted for 12 ounce cans to make the comparison easier to see. However, it's important to remember that not everything is served at this size, some being at 16 or even 20 ounce cans or bottles.

Now it wasn't shocking that near the top of the chart I saw Mountain Dew (54 mg), Mountain Dew Black ([62.3 mg] (https://www.caffeineinformer.com/caffeine-content/md-black-label)) or Mountain Dew Game Fuel (72.6) However some of the more surprising ones to see up there included Pepsi One at 54 mg, Pepsi Zero Sugar at 69 mg or Diet Coke at 57 mg.

Even though I'm not a huge soda drinker, I'd always heard of regular Mountain Dew having higher caffeine levels that regular sodas. So seeing Diet Coke and Pepsi equaling or beating it was unexpected.

To fall within the 400 mg safe daily limit of caffeine, this would allow for up to 6 to 8 sodas (12 oz) to be drank. It's worth noting that there are some other soft drinks with higher levels, I just listed some of the more common brand names here.

While the health effects of drinking lots of soda are rather well known such as putting on weight and sugar intake, the caffeine portion tends to not even be mentioned.

I did see one report of a woman's death being attributed to excessive soda intake, but it seemed to be more an effect of the sugar versus the caffeine. It was said the she amazingly drank over two gallons of soda per day!

Energy Drinks

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This is where things can get a little dicey. It's worth mentioning that energy drinks and shots aren't regulated by the FDA, meaning they don't have to label it's ingredients or caffeine levels, instead they can just list proprietary energy blend.

Energy drink manufacturers—just like all other manufacturers—are not required by the Food and Drug Administration to disclose the amount of caffeine in their products,” says William Wallace, a policy analyst at Consumers Union, the policy and mobilization arm of Consumer Reports.
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Consumer reports did their own tests on 27 energy drinks finding not all of those that did label caffeine levels were correct with "Some under-reporting it by 20% or more as while one actually have 70% less." A few of their findings showed the energy shots topping the list with 5 hour energy at 215mg per container with 5 hour energy extra strength reaching 242mg. Some of the larger drinks also showed extremely high levels (which I broke down to 12 ounces for easier comparison, even though the can sizes vary):

Spike Energy Drink - 262.5mg
Wired X344 Energy Drink - 258mg
Many Rockstar Energy Drinks - 180mg
Java Monster - 150.4 mg
Mega Monster Energy Drink - 120mg
Full Throttle - 120mg
NOS Energy Drink - 120mg
Red Bull - 113.5mg

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A full list can be seen here.

Cardiologist Anna Svatikova, M.D., Ph.D. at the Mayo clinic researched these drinks said...

[they] contain other ingredients that act as stimulants, such as taurine, guarana, and ginseng. But not all of the ingredients have been well-studied in terms of cardiovascular effects.
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Today's news of a teen's death being attributed to a caffeine overdose. Other reports over the last handful of years can also be found attributing people passing away to energy drinks. Unfortunately, none of them seem to say which drinks were actually involved, which seems like an important aspect with both caffeine levels and other "energy ingredients" varying among them.

As you can see, there is a HUGE range of actual caffeine levels per ounce. But it's important to remember these all come in varying can sizes with Red Bull only being a little over 8 ounces per can with others being 16 ounce sizes. But there is no denying that the energy shots are WAY more dense with caffeine.

Conclusion / TL;DR

There are tons of news stories today about David Cripe's death being attributed as a caffeine overdose by the coroner.

While I feel bad for the boy, his friends and family for their loss...the news seems to be missing what I would think are important pieces of information. It simply attributes it to caffeine levels, even though caffeine alone hasn't seem to show a history of acutely causing death from an irregular heartbeat. Also, it doesn't mention what brand of energy drink or soda was involved, nor the size of the coffee. These factors could easily have put him above OR below the 400mg safe limit (even though his personal limit may have been lower.)

I'm very curious if there was any history that could have led to this and/or the specifics of the drinks. This just as easily could have been effected by unspecified "energy ingredients" in the energy drink, which would lead anyone looking into this down a vary different path instead of pure caffeine levels.

[UPDATE: The coroner has refined his wording saying that is was not an caffeine overdose but rather ingesting too much over a short period of time. Quotes are included below.]

The teenager weighed 90kg (200 lbs) but would not have been considered morbidly obese, Mr Watts said.
"This is not a caffeine overdose," Mr Watts told Reuters news agency.
"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."
Caffeine would probably not have been seen as a factor in the teenager's death if witnesses had not been able to tell officials what he had been drinking before his death, the Richland County coroner said.
The main witness could not say which brand of energy drink Davis drank but said it was from a container the size of a large soft drink.
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