{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T18:57:48Z","timestamp":1779217068069,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2013NextGenerationEU through the National Recovery and Resilience Plan of the Republic of Bulgaria","award":["BG-RRP-2.004-0009-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0009-C02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoX"],"abstract":"<jats:p>Caffeine is widely consumed and generally considered safe at customary doses. How-ever, high-dose preparations available online pose a risk of severe and potentially fatal intoxication. Although uncommon, lethal caffeine poisoning is associated with profound cardiovascular and neurological toxicity. A rare case of intentional acute caffeine intoxication with fatal outcome is presented. A 25-year-old woman ingested an estimated 60 tablets containing 200 mg of caffeine each, purchased online. She was admitted to hospital shortly after ingestion of the caffeine tablets with palpitations, agitation, dizziness, and repeated vomiting. On examination, she presented with arterial hypotension (90\/60 mmHg) and marked sinus tachycardia (150 beats\/min), accompanied by psychomotor agitation. Her blood caffeine concentration measured by means of high-performance liquid chromatography (HPLC) was 177 \u00b5g\/mL. The patient\u2019s condition rapidly deteriorated, with the development of convulsive syndrome progressing to coma, extreme ventricular tachycardia, exotoxic shock, and toxic cardiomyopathy. Despite intensive care management, including mechanical ventilation and advanced cardiopulmonary resuscitation, the patient died several hours after admission. In conclusion, this case underscores the life-threatening potential of acute high-dose caffeine ingestion and highlights the risk associated with unrestricted access to concentrated caffeine products. Early recognition and aggressive management are crucial, yet may be insufficient in cases of massive overdose.<\/jats:p>","DOI":"10.3390\/jox16020056","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:02:49Z","timestamp":1774339369000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Intoxication with Caffeine-Containing Tablets: A Case Report with a Fatal Outcome"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5778-4043","authenticated-orcid":false,"given":"Maya","family":"Radeva-Ilieva","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0528-0289","authenticated-orcid":false,"given":"Stanila","family":"Stoeva-Grigorova","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1911-4755","authenticated-orcid":false,"given":"Ivanesa","family":"Yarabanova","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivelina","family":"Panayotova","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6220-4020","authenticated-orcid":false,"given":"Georgi","family":"Bonchev","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadezhda","family":"Hvarchanova","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Milkov","sequence":"additional","affiliation":[{"name":"Department of Dental Materials Science and Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simeon","family":"Marinov","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petko","family":"Marinov","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Snezha","family":"Zlateva","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rodak, K., Kokot, I., and Kratz, E.M. 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