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.
Table 1
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 |
Fig. 2
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]
Table 2
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 |
Table 3
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] |
[i] Afib: Atrial fibrillation; AKI; Acute kidney injury; CVVHF: Continuous veno-venous hemodiafiltration; ECMO: Extracorporeal membrane oxygenation; PAC: Premature atrial contraction; PEA: Pulseless electrical activity; PVC: Premature ventricular contraction; SVT: Supraventricular tachycardia; VF: Ventricular fibrillation; VT: Ventricular tachycardia