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Treatment of Lethal Caffeine Overdose with Haemodialysis: A Case Report and Review

Christian C Toquica Gahona
Christian C Toquica Gahona
, 
Ashwin Kodagnur Bharadwaj
Ashwin Kodagnur Bharadwaj
, 
Monarch Shah
Monarch Shah
, 
Umesh Bhagat
Umesh Bhagat
, 
Paul Sterman
Paul Sterman
 e 
William Vasquez
William Vasquez
   | 12 nov 2022
The Journal of Critical Care Medicine's Cover Image
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Article Category: Case Report
Pubblicato online: 12 nov 2022
Pagine: 279 - 287
Ricevuto: 19 lug 2022
Accettato: 24 lug 2022
DOI: https://doi.org/10.2478/jccm-2022-0019
Parole chiave
© 2022 Christian C Toquica Gahona, Ashwin Kodagnur Bharadwaj, Monarch Shah, Umesh Bhagat, Paul Sterman, William Vasquez, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig.1

Electrocardiogram showing tachycardia with an undetermined rhithm, HR-108/min, normal axis, ST segment depression in V2-V3, and multiple premature ventricular contractions.
Electrocardiogram showing tachycardia with an undetermined rhithm, HR-108/min, normal axis, ST segment depression in V2-V3, and multiple premature ventricular contractions.

Fig. 2

Relationship of heart rate in response of initiation of treatment with hemodialysis. Arrow showing time of initiation of hemodialysis.
Relationship of heart rate in response of initiation of treatment with hemodialysis. Arrow showing time of initiation of hemodialysis.

Fig. 3

Physiological effects of caffeine intoxication. Adapted from Colin-Benoit et al. [39]
Physiological effects of caffeine intoxication. Adapted from Colin-Benoit et al. [39]

Laboratory results during hospital course.

Laboratory test Admission day Day 2 Day 3 Day 4
WBC (4.0-11.0 10 3/cumm) 16.9 16 7.3
ABS lymphocytes 5.6 2.6
HGB (12.0-16.0 g/dL) 14.1 13.2 13.6
Platelet count (150-400 10 3/cumm) 335 263 236
BUN (9-28 mg/dL) 11 7 12 13
Creatinine (0.52-1.04 mg/dL) 0.72 0.92 0.98 1.06
AST (SGOT) (14-36 U/L) 20
ALT (SGPT) (9-52 U/L) 23
CO2 (21-33 mmol/L) 19 21 24 31
Anion gap 15 17 8 6
Lactic acid (0.5-2.0 mmol/L) 5.2-4.7-1.6 0.6
BNP *10.0-100.0 pg/mL) <10
Troponin-I (< 0.12 ng/mL) <0.03 <0.03
Protein (6.0-8.0 g/dL) 5.7
Albumin (3.2-4.6 g/dL) 3.7
Calcium (8.4-10.0 mg/dL) 6.5 8.4 8.5 8.9
Glucose (82-115 mg/dL) 197 112 90 87
Total bilirubin (0.1-1.2 mg/dL) 0.4
ALK phosphatase (53-141 U/L) 43
Sodium (136-145 mmol/L) 140 138 139 138
Potassium (3.5-5.1 mmol/L) 2 3.6 4 4.3
Chloride (99-112 mmol/L) 106 104 104 101
Magnesium (1.60-2.66 mg/dL) 1.2 1.5 1.4 1.7
Caffeine in serum (8.0-20.0 mg/L) >90 6.7
Alcohol (ethanol) <10 mg/dL = None Detected
Acetaminophen Negative
Anphetamine, urine Negative
Barbituates, urine Negative
Benzodiazepine, urine Negative
Cocaine, urine Negative
Methadone, urine Negative
Opiates, urine Negative
PCP, urine Negative
Salicylate, urine Negative
THC Negative

Cases of caffeine intoxication treated with hemodialysis.

Age/ Gender Arrhythmias Laboratory abnormalities Treatment Caffeine level (mg/L) Outcome
37/F SVT, PVCs, VT, VF Leukocytosis, hyperglycemia, meta- bolic acidosis Hemoperfusion, gastric lavage, activated charcoal, norepinephrine, dopamine 199 Recovery [25]
21/F PAC, PVCs, VT, VF Metabolic acidosis, Hyponatremia, hypokalemia, hyperglycemia, Hemoperfusion, activated charcoal 297 Recovery [26]
21/M None reported Rhabdomyolysis, renal failure, Hyper- glycemia, hypokalemia Peritoneal dialysis Not reported Recovery [27]
36/- Rhabdomyolysis, renal failure, Hemodialysis - Recovery [28]
41/M Wide complex tachy- cardia, bradycardia, 3rd degree AV block, asystole, PEA. Leukocytosis, hypokalemia, hypergly- cemia, Metabolic acidosis, Rhabdo- myolysis Hemodialysis and norepineph- rine, dopamine, epinephrine, Vasopressin 405 Recovery [29]
18/M EKG: Prolonged QTc, ST abnormalities, SVT, PEA, Leukocytosis, hypokalemia, Hemodialysis, Phenylephrine and lidocaine infusions. 0.725 Recovery [30]
39/F Broad complex tachycardia Lactic acidosis, metabolic acidosis, hypokalemia, hyperglycemia, Rhabdo- myolysis Activated charcoal, Epineph- rine, dobutamine, CVVHF, hemodialysis 574 Recovery [31]
43/M None reported Leukocytosis, hypokalemia, hyper- glycemia, Lactic acidosis, AKI, renal failure Hemodialysis, Activated char- coal, gastric lavage, Pressors. 60 Recovery [32]
36/M None reported No mention Hemodialysis, Activated char- coal, gastric lavage. 66 Recovery [32]
27/F VF, Cardiac arrest Hypokalemia, metabolic acidosis, Hemofiltration Not reported Recovery [33]
42/M None reported Leukocytosis, Rhabdomyolysis, Hyper- kalemia, renal failure Hemodialysis Not reported Recovery [34]
44/M VF, Cardiac arrest Leukocytosis, hyperglycemia, Rhabdo- myolysis, Troponemia, ECMO, CVVHF 145.2 Death [35]
32/M VT Hypokalemia Hemoperfusion and hemodi- alysis 200-250 Recovery[36]
50/F EKG: VT, torsades des pointes, VF, ar- rest, prolonged QTc Metabolic acidosis, Lactic acidosis, hypokalemia Norepinephrine and epineph- rine, amiodarone, gastric lavage and charcoal, infusion of intralipid, and CVVHF 311 Recovery [37]
36/M Sinus tachycardia, PACs, Leukocytosis, hypokalemia, hypergly- cemia, AKI, rhabdomyolysis. Hemodialysis 80.16 Recovery [38]
21/M EKG: Sinus tachycar- dia, RBBB Leukocytosis, hypokalemia, hyper- glycemia, Elevated CKP, Metabolic acidosis, lactic acidosis Hemodialysis and hemofiltra- tion, Amiodarone. 150 Recovery [39]
24/M Sinus tachycardia Rhabdomyolysis, renal failure, leuko- cytosis, hypokalemia, lactic acidosis. Hemodialysis, activated char- coal, vasopressors 70 Recovery [40]
43/F EKG: Wide QRS tachycardia, torsades des pointes, VF. Car- diac arrest, AFib Lactic acidosis, Metabolic acidosis, hypokalemia, AKI, Rhabdomyolysis, hypoglycemia ECMO, Continuous hemody- alisis, activated charcoal, lipid emulsion, Vasopressors. 251.9 Recovery [41]
69/M EKG: SVT, PVC, Bigeminy Hypokalemia, Rhabdomyolysis, Meta- bolic acidosis, Lactic acidosis Hemodialysis, Esmolol, 254 Recovery [42]
26/F EKG: polymorphic VT metabolic acidosis, Lactic acidosis, hypokalemia Hemodialysis, intravenous lipid, vasopressors, 147.1 Recovery [43]
43/M EKG: Wide QRS com- plex tachycardia Hypokalemia, lactic acidosis ECMO, Hemodialysis 66 Recovery [44]
-/- EKG: SVT Hypokalemia, Metabolic acidosis, lactic acidosis, elevated CPK, Hemodyalisis, activated char- coal. 118.06 Recovery [45]

Toxic and lethal caffeine doses and concentrations.

Dose effects of caffeine Dose
Toxic dose 2 g
Toxic concentration 15 mg/L
Lethal dose 10-20 g
Lethal concentration 80 mg/L
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