RESUMO
A 51-year-old man presented with sudden-onset palpitations and dyspnea that had started 8 h earlier. The patient was restless and tachypneic and had persistent vomiting upon arrival. His sensorium and oxygen saturation levels rapidly declined three hours after arrival, and he was placed on a ventilator. On hospitalization day 2, he was removed from the ventilator and claimed that he had consumed a large amount of energy drinks (oral caffeine intake, approximately 1 g). The theophylline level on arrival had been elevated (9.0 µg/mL). Caffeine intoxication should be considered in patients presenting with restlessness, tachypnea, frequent vomiting, lactic acidosis, and electrolyte abnormalities.
Assuntos
Cafeína , Teofilina , Humanos , Masculino , Cafeína/efeitos adversos , Cafeína/intoxicação , Cafeína/sangue , Pessoa de Meia-Idade , Teofilina/sangue , Teofilina/efeitos adversos , Bebidas Energéticas/efeitos adversosRESUMO
INTRODUCTION: Study Summary: In today's world, caffeine is the most commonly consumed psychostimulant globally. While moderate caffeine intake is generally safe, there have been reported cases of significant toxicity and even fatal outcomes. Although rare, increased awareness and clinical suspicion are crucial in identifying such cases and providing timely life-saving interventions. In this report, we present a case of a 27-year-old female patient who was hospitalized due to severe systemic and cardiac effects resulting from the ingestion of a large quantity of caffeine capsules as a suicide attempt. We provide a detailed account of the clinical presentation and the management of the patient, including the emergency room's life-saving interventions and the complex care provided in the intensive care unit until the patient's complete recovery. Our aim with this case presentation is to raise awareness about the severe consequences of caffeine intoxication, particularly the cardiac injury, and to highlight the state-of-the-art treatment approaches in addressing this issue.
Assuntos
Arritmias Cardíacas , Cafeína , Estimulantes do Sistema Nervoso Central , Adulto , Feminino , Humanos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Intoxicação/terapia , Tentativa de SuicídioRESUMO
We discuss the current status of, and possible countermeasures for, acute drug poisoning among adolescents using OTC drugs. In the last 10 years, 36 patients aged <20 years who overdosed on OTC drugs were examined for the type of drug ingested, its active ingredients in cases of lethal dose intake, and the relevant place of purchase. Patients aged <20 years accounted for 30% of all the cases. The ingestion of multi-ingredient common-cold medication was the highest at 23%, and no ingestion of any first-class OTC drugs was observed. Caffeine accounted for 54% of the cases of lethal dose intake. At 80%, the most common method of drug purchase was from drugstores and other OTC vendors. In recent years, the number of adolescents patients who take lethal doses of OTC drugs has been increasing, and new measures are needed to avoid such cases. School pharmacists and vendors play a major role in reducing the incidences of drug poisoning. As drugs can be easily purchased over the counter, increasing the vendors' awareness of the problem throughout society may be the quickest way to reduce the incidences of acute drug poisoning among adolescents.
Assuntos
Comportamento do Adolescente , Comportamento do Consumidor , Uso Indevido de Medicamentos/prevenção & controle , Uso Indevido de Medicamentos/estatística & dados numéricos , Medicamentos Compostos contra Resfriado, Influenza e Alergia/intoxicação , Medicamentos sem Prescrição/intoxicação , Doença Aguda , Adolescente , Fatores Etários , Cafeína/intoxicação , Comércio , Feminino , Humanos , Incidência , Masculino , Medicamentos Compostos contra Resfriado, Influenza e Alergia/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Farmácias , Fatores de TempoRESUMO
BACKGROUND: The use of dietary supplements by young warfighters is pervasive and comes with a readiness cost, especially in the deployed setting. Predatory targeting and marketing by various unscrupulous companies put this population at risk for a higher than baseline risk for adverse events. METHODS: We report on 6 serious adverse events experienced by warfighters while deployed in Kuwait and Afghanistan. Presented is a discussion of current practice gaps and solutions, as well as details regarding how polypharmacy contributes to the seriousness of the threat posed by problematic supplements. RESULTS: The morbidity associated with the 6 cases of dietary supplement adverse events compromised mission readiness and was costly in terms of health and health care expenditures. CONCLUSION: The military dietary supplement issue needs exposure, review, and action at the highest levels of government.
Assuntos
Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Suplementos Nutricionais/efeitos adversos , Distonia/induzido quimicamente , Ginecomastia/induzido quimicamente , Hiperbilirrubinemia/induzido quimicamente , Militares , Rabdomiólise/induzido quimicamente , Adulto , Humanos , Masculino , Saúde Militar , Polimedicação , Adulto JovemRESUMO
BACKGROUND: Caffeine poisoning may cause life-threatening arrhythmias and hemodynamic failure. We aimed to investigate the toxicokinetics (TK), toxicodynamics (TD) and TK/TD relationships of caffeine in a case of poisoning. CASE REPORT: A 47-year-old male ingested pure anhydrous caffeine powder (70 g) in a suicide attempt. He developed agitation, tachycardia, and two episodes of ventricular fibrillation treated with defibrillation and tracheal intubation. He was successfully managed using intravenous infusions of esmolol and norepinephrine. METHODS: We modelled the time-course of plasma caffeine concentration (TK study using online liquid chromatography-tandem mass spectrometry), the time-course of blood lactate concentration and infusion rates of esmolol and norepinephrine (TD studies) and the TK/TD relationships. RESULTS: Caffeine TK was of first-order peaking at 258 mg/L with an elimination half-life of 46.2 h and clearance of 2.2 L/h. Caffeine-related effects on blood lactate (peak, 10 mmol/L at 1.25 h postingestion) were described by a Bateman-type equation (formation rate, 0.05 mmol/mg.h; elimination rate, 0.9 mmol/mg.h). Esmolol and norepinephrine infusion rates to reverse caffeine-related cardiovascular effects (peaks at 51-h postingestion) fitted well with a sigmoidal Emax model (EC50, 180.0 and 225.9 mg/L, respectively; Hill coefficient, 10.0). CONCLUSION: Massive caffeine ingestion is characterized by prolonged caffeine elimination. TK/TD relationships are helpful to quantify caffeine-related catecholaminergic effects.
Assuntos
Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Frequência Cardíaca/efeitos dos fármacos , Tentativa de Suicídio , Taquicardia/induzido quimicamente , Fibrilação Ventricular/induzido quimicamente , Administração Oral , Agonistas alfa-Adrenérgicos/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Cafeína/administração & dosagem , Cafeína/farmacocinética , Cardiotoxicidade , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/farmacocinética , Cardioversão Elétrica , Meia-Vida , Humanos , Hiperlactatemia/induzido quimicamente , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Pós , Propanolaminas/administração & dosagem , Taquicardia/diagnóstico , Taquicardia/fisiopatologia , Taquicardia/terapia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapiaRESUMO
BACKGROUND: Caffeine is a widely used dietary stimulant, and cases of caffeine overdoses, sometimes leading to death, are increasing. We encountered a case of caffeine intoxication resolved with administration of the sedative agent dexmedetomidine. CASE PRESENTATION: We administered dexmedetomidine for sedation and to suppress sympathetic nerve stimulation in the case of an 18-year-old Japanese male who ingested a massive dose of caffeine with the intention of committing suicide. The patient was in an excited state and had hypertension, sinus tachycardia, and hypokalemia with prominent QT prolongation. After dexmedetomidine administration, the patient's mental state, hemodynamics, and electrolyte levels were improved immediately. He was discharged without any sequelae 3 days later. CONCLUSION: Cases of acute caffeine intoxication with agitation, sympathetic overactivity and adverse cardiac events would benefit with dexmedetomidine treatment.
Assuntos
Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Dexmedetomidina/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Tentativa de Suicídio , Acidose Láctica/induzido quimicamente , Acidose Láctica/tratamento farmacológico , Adolescente , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Eletrocardiografia , Lavagem Gástrica , Humanos , Hipertensão/induzido quimicamente , Hipertensão/tratamento farmacológico , Hipopotassemia/induzido quimicamente , Hipopotassemia/tratamento farmacológico , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/tratamento farmacológico , Masculino , Potássio/uso terapêutico , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológicoRESUMO
Caffeine, a naturally occurring purine-based alkaloid, is the most consumed psychostimulant worldwide. Since caffeine pharmacokinetics shows extreme interindividual variability, it is not easy to establish its toxic dose. Only a few cases of death due to acute caffeine intoxication have been described so far, the majority of which attributable to massive assumption of caffeine-based medications. We present a case of acute caffeine overdose due to ingestion of pure caffeine. The extremely high blood concentration of caffeine determined a strong cardiovascular response, leading to fatal arrhythmia, as supported by histological evidence of myocardial injury. Quantitation of catecholamines and their metabolites in urine samples was performed and showed level near the highest limit of normal ranges for norepinephrine and high level of epinephrine. Contraction band is a pathological modification of the myocell caused by the catecholaminergic action and can occur in conditions of alteration due to the interaction between calcium and catecholamines. We demonstrated the ß1-adrenoceptor involvement in our fatal case by immunohistochemical analysis.
Assuntos
Arritmias Cardíacas/induzido quimicamente , Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Frequência Cardíaca/efeitos dos fármacos , Receptores Adrenérgicos beta 1/metabolismo , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatologia , Cafeína/farmacocinética , Estimulantes do Sistema Nervoso Central/farmacocinética , Epinefrina/urina , Evolução Fatal , Feminino , Humanos , Norepinefrina/urinaRESUMO
Caffeine is a common stimulant consumed daily worldwide and available in a wide variety of over-the-counter formulations. It is a mild central nervous system stimulant when used in recommended doses. However, it can be fatal if taken as an intentional or accidental overdose. We report a case of a 48-year-old lady with depression and post-traumatic stress disorder who consumed a significant overdose of caffeine, triggered by the stress that she had contracted coronavirus disease 19. This led to significant cardiovascular and central nervous system toxicity. The condition was identified early and managed appropriately with early ß-blockers and gastric decontamination, which saved her life. There are few studies with regard to such modalities on treatment for caffeine overdose; our patient responded rapidly and favourably to the treatment. Why should an emergency physician be aware of this? Caffeine overdose is uncommon but one that clinicians should be aware of. Early identification and intervention with ß-adrenergic antagonists and activated charcoal is paramount in caffeine toxicity.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Cafeína/intoxicação , Overdose de Drogas/terapia , Lavagem Gástrica/métodos , COVID-19/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
Caffeine occurs naturally in various foods, such as coffee, tea, and cocoa, and it has been used safely as a mild stimulant for a long time. However, excessive caffeine consumption (1~1.5 g/day) can cause caffeine poisoning (caffeinism), which includes symptoms such as anxiety, agitation, insomnia, and gastrointestinal disorders. Recently, there has been increasing interest in the effect of caffeine consumption as a protective factor or risk factor for neurological and psychiatric disorders. Currently, the importance of personalized medicine is being emphasized, and research on sex/gender differences needs to be conducted. Our review focuses on the effect of caffeine consumption on several neurological and psychiatric disorders with respect to sex differences to provide a better understanding of caffeine use as a risk or protective factor for those disorders. The findings may help establish new strategies for developing sex-specific caffeine therapies.
Assuntos
Cafeína/administração & dosagem , Cafeína/efeitos adversos , Transtornos Mentais/etiologia , Transtornos Mentais/prevenção & controle , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Medição de Risco , Caracteres Sexuais , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cafeína/intoxicação , Cafeína/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
A 49-year old man was found dead at home next to a glass containing a dried, white, crystalline substance and near a bag containing pills with the imprint XANAX, the trade name of alprazolam. A comprehensive screening of material collected during the autopsy revealed the presence of etizolam and caffeine in lethal concentrations (0.77 µg/mL and 190 µg/mL) but no trace of alprazolam. Benzodiazepine analogue etizolam is rarely prescribed in Germany, and as a result there are not many reports about fatal cases. It has anxiolytic, hypnotic, sedative and muscle-relaxant properties and is used for the short-term treatment of anxiety and panic attacks. The purine alkaloid caffeine, conversely, is the most widely used central nervous system stimulant. The following report outlines potentially the first reported case of a lethal combination of the downer etizolam and the upper caffeine in medical literature.
Assuntos
Cafeína/intoxicação , Diazepam/análogos & derivados , Alprazolam , Medicamentos Falsificados , Diazepam/intoxicação , Diazepam/urina , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 33-year-old woman experienced 90 min of in-hospital cardiac arrest following an intentional overdose of anhydrous caffeine powder. In the face of prolonged and apparently futile resuscitation attempts, high-dose insulin euglycemic therapy was initiated. A loading dose of 1 IU/kg/h of IV insulin resulted in a dramatic improvement in perfusion. This was augmented by a 72-h infusion reaching a maximal rate of 10 IU/kg/h. The patient recovered full neurologic function and survived to discharge. Although high-dose insulin is effective in beta-blocker, calcium channel blocker, and tricyclic antidepressant overdose, this is seemingly the first description of its successful use in caffeine toxicity.
Assuntos
Cafeína/intoxicação , Overdose de Drogas/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Parada Cardíaca Extra-Hospitalar/induzido quimicamente , Adulto , Feminino , HumanosRESUMO
A 26-year-old woman presented after an intentional ingestion of 20 g of caffeine. She suffered a profound respiratory alkalosis with metabolic acidosis, hypokalaemia and sustained polymorphic ventricular tachycardia. She was treated with intravenous intralipid and haemodialysis, and her arrhythmia was controlled using magnesium sulphate. Once invasively ventilated and unable to hyperventilate the patient became acidotic and required intravenous bicarbonate to correct her acid-base status. Two days following the overdose the patient was extubated, haemodialysis was stopped and norepinephrine was weaned off. The patient was discharged after a further 7 days. Serial caffeine levels were taken during this patient's care; the highest measured caffeine concentration 7 hours after ingestion was 147.1 mg/L. The known lethal dose of caffeine is 80 mg/L. Intralipid and haemodialysis represent a new and viable treatment in life-threatening caffeine overdose. Intravenous magnesium may terminate unstable arrhythmias in caffeine-poisoned patients.
Assuntos
Acidose/terapia , Cafeína/intoxicação , Hipopotassemia/terapia , Fosfolipídeos/uso terapêutico , Diálise Renal , Óleo de Soja/uso terapêutico , Taquicardia Ventricular/terapia , Acidose/induzido quimicamente , Adulto , Antiarrítmicos/uso terapêutico , Overdose de Drogas , Emulsões/uso terapêutico , Emulsões Gordurosas Intravenosas/uso terapêutico , Feminino , Humanos , Hipopotassemia/induzido quimicamente , Sulfato de Magnésio/uso terapêutico , Tentativa de Suicídio , Taquicardia Ventricular/induzido quimicamenteRESUMO
Caffeine is the most commonly ingested psychoactive substance in the world. Although caffeine-use disorder is not recognized as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, five disorders related to caffeine use are enumerated therein. An evolving literature suggests that caffeine is one of many licit substances that may cause psychotic symptoms in higher doses. Here, we present a case in which a defendant ingested large quantities of caffeine, which result in transient psychosis and a successful affirmative defense of involuntary intoxication. The purpose of this article is to summarize states' statutory approaches to involuntary intoxication, given that the term is defined variably, if defined at all. Evaluators must be careful to apply jurisdictionally appropriate standards in involuntary intoxication defenses because the bar for this total defense differs across localities.
Assuntos
Cafeína/intoxicação , Legislação como Assunto , Psicoses Induzidas por Substâncias , Adolescente , Adulto , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Jurisprudência , Responsabilidade Legal , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Bidirectional ventricular tachycardia (BVT) is a tachyarrhythmia characterized by 180-degree beat-to-beat alteration in the QRS axis. BVT is traditionally known as an electrocardiography (ECG) finding pathognomonic of digitalis poisoning and a hallmark of catecholamine-induced ventricular tachycardia. Apart from digitalis poisoning, aconitine poisoning is the only reported cause of poisoning-related BVT, and no report of caffeine-poisoning-related BVT is as yet available. A-27-year-old woman was transported to hospital with cardiac arrest from ventricular fibrillation after taking a massive dose of a caffeine-containing supplement (corresponding to 6â¯g of caffeine) 6â¯h before presentation. Return of spontaneous circulation (ROSC) was achieved by defibrillation. She developed BVT after ROSC. Hemodialysis was performed to remove the causative drug from the blood, with subsequent resolution of BVT and hemodynamic stabilization. At presentation, she had a blood caffeine concentration of 232⯵g/mL. A suggested mechanism of development of BVT is that increased intracellular calcium concentration causes delayed afterdepolarization, which induces alternate occurrence of triggered activities within different His-Purkinje fibers, and thereby produces characteristic ECG findings. Caffeine acts on the ryanodine receptor to promote calcium release from the sarcoplasmic reticulum, and thus can induce BVT via the same mechanism. Caffeine poisoning can be treated by dialysis. In cases of BVT induced by caffeine poisoning, hemodynamic stabilization can be achieved by emergency dialysis.
Assuntos
Cafeína/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Taquicardia/induzido quimicamente , Adulto , Feminino , Humanos , Taquicardia/diagnósticoAssuntos
Fibrilação Atrial/induzido quimicamente , Cafeína/intoxicação , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Tentativa de Suicídio , Taquicardia Supraventricular/induzido quimicamente , Taquicardia Ventricular/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cafeína/sangue , Overdose de Drogas , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Síndrome do QT Longo/sangue , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taquicardia Supraventricular/sangue , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Taquicardia Ventricular/sangue , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologiaAssuntos
Cafeína/intoxicação , Overdose de Drogas/terapia , Hemoperfusão/métodos , Diálise Renal/métodos , Cafeína/sangue , Bebidas Energéticas/efeitos adversos , Hemoperfusão/economia , Humanos , Japão , Masculino , Diálise Renal/economia , Tentativa de Suicídio , Resultado do Tratamento , Adulto JovemRESUMO
A 27-year-old man presented with an intentional overdose of concentrated caffeine powder that he bought over the internet. The patient received benzodiazepines and ondansetron for symptomatic treatment when he arrived in the Emergency Department (ED). Subsequently, he developed recurrent supraventricular tachycardia in the ED. The SVT was successfully treated with metoprolol. The patient's caffeine level was >90â¯mg/L. This is the first known report of treatment of caffeine-induced supraventricular tachycardia with metoprolol.
Assuntos
Antiarrítmicos/uso terapêutico , Cafeína/intoxicação , Overdose de Drogas/tratamento farmacológico , Metoprolol/uso terapêutico , Taquicardia Supraventricular/induzido quimicamente , Taquicardia Supraventricular/tratamento farmacológico , Adulto , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Tentativa de Suicídio , Taquicardia Supraventricular/diagnósticoRESUMO
Caffeine (1,3,7-trimethylxanthine) is a natural product commonly presented in food's composition, beverages and medicinal products. Generally, it is thought to be safe under normal dosage, yet it can be fatal in case of severe intoxication. We report a case of a healthy 32-year-old woman who went to the local emergency department (ED) 30 min after ingesting, accidentally, 5000 mg of anhydrous caffeine for a preworkout supplement. At the ED, she presented an episode of presyncope followed by agitation. ECG showed polymorphic broad complex QRS tachycardia and arterial blood gas revealed metabolic acidaemia with severe hypokalemia. The dysrhythmia was successfully treated with intravenous propranolol. Acid-base and hydroelectrolytic disorders were also corrected. A persistent sinus tachycardia was observed in the first 2 days in the ward and 5 days later she was discharged asymptomatic with internal medicine follow-up.