Abstract: SA-PO1018
Caffeine Overdose: Case Report
Session Information
- Fellows/Residents Case Reports: Fluid, Electrolytes, Acid Base
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Hipp, Andrew, Hennepin County Medical Center, Minneapolis, Minnesota, United States
- Eidman, Keith E., Hennepin County Medical Center, Minneapolis, Minnesota, United States
Background
Caffeine is a ubiquitous stimulant in today’s society. Massive caffeine ingestion, although rare, is associated with life threatening complications. This case involves a patient presenting after intentional caffeine overdose of approximately 20g(LD50 for patient is 6g). Previous case reports have demonstrated hemodialysis as an effective treatment. Dialysis treatment directed by hemodynamic parameters was used in this case and proved helpful in guiding repeat dialysis treatments as caffeine levels were not readily available.
Methods
The patient was brought in following an intentional overdose of caffeine pills. Patient presented with hypotension, tachycardia, hypokalemia, and depressed mental status. Patient was treated with IVF, sedation, intubation, and blood pressure support with phenylephrine. Hemodialysis was started in the setting of massive ingestion and ongoing hemodynamic instability. Patient underwent hemodialysis using a high flux dialyzer with improvement in both tachycardia and blood pressure. Patient required a second run of hemodialysis after decompensating after cessation of the first run and required placement back on phenylephrine. Following the completion of a second run, the patient remained hemodynamically stable and off vasopressor support. Caffeine levels prior to HD eventually returned at 187.5 mcg/ml. Post first HD run caffeine levels improved to 57 mcg/ml and subsequently to 6.0 mcg/ml after second run of HD.
Conclusion
Caffeine and it numerous metabolites including theophylline, theobromine, and paraxanthine can cause life threatening hemodynamic instability. The mechanism of caffeine and its metabolites actions are through adenosine antagonism, catecholamine release, and phosphodiesterase inhibition. Caffeine is a suitable target for removal with Vd of 0.6 L/kg, small molecular weight, and only 25-36% protein bound. This case demonstrates acute hemodialysis is indicated in massive caffeine ingestion and treatment can be directed by hemodynamic parameters.