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

Gahona, Christian C Toquica; Bharadwaj, Ashwin Kodagnur; Shah, Monarch; Bhagat, Umesh; Sterman, Paul; Vasquez, William

doi:10.2478/jccm-2022-0019

Figures & Tables

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

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

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

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

Figures & Tables

Fig.1

Fig. 2

Fig. 3

Laboratory results during hospital course_

Cases of caffeine intoxication treated with hemodialysis_

Toxic and lethal caffeine doses and concentrations_

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