Background: Caffeine and its derivatives are CNS and cardiac stimulants, which are routinely detected in toxicology samples due to dietary exposure. However, despite its wide-spread use, severe poisoning is rare. While there are no well-established guidelines for lethal dose, ingestion of 150 mg/kg is considered potentially lethal. In fatalities, post-mortem blood concentrations exhibit a wide range (79 . 344 mg/L) and post mortem redistribution has been postulated as a cause of this variability. Case report: A 36-year-old woman was found dead lying on her hotel bed, an apparent suicide with note of intent found on scene. A drinking glass containing pink powder residue was on the floor. No items in the room corresponded to the glass residue. A bottle of clonazepam, prescribed to the decedent, was noted and pill count correlated with the fill date of prescription. Autopsy was significant for diffuse pulmonary edema, apparent medication sediment in the gastric contents, and no anatomic cause of death was appreciated. Qualitative drug screen was positive for caffeine and salicylate via chromatography. Quantitative clonazepam and 7-amino clonazepam levels fell within the therapeutic range at 4.4 ng/mL and 71 ng/mL, respectively. Quantitative salicylate level was 1.5 mg/dL, well below the established reference range. At this time no cause of death had been determined. The possibility of caffeine toxicity was proposed and both a quantitative caffeine level and qualitative testing of the drinking glass residue were obtained. Glass residue was positive for caffeine and the quantitative caffeine level was significantly elevated at 240.0 mcg/mL. All quantitative testing was run from femoral blood samples. Based upon these results, the death was certified as caffeine toxicity. Case discussion: The ever expanding sources and availability of caffeine-containing products, combined with lack of public knowledge regarding caffeine toxicity, are likely to result in an increase in healthcare visits and fatalities from caffeine intoxication. Deaths attributed to caffeine, evidenced by the recent death of a 14-year-old girl in Maryland after consuming energy drinks, make for sensational media coverage. Medical examiners and toxicologists are likely to be sought out to comment on this growing trend. This case emphasizes the importance of post-mortem drug testing, which should continue to include screening for caffeine and its metabolites. Conclusions: Medical examiners and toxicologists should not discount the significance of positive results on qualitative drug assays for commonly abused substances such as caffeine. Quantitative values should be obtained in such cases where cause of death is not attributable to other easily identifiable means.