Abstract: FR-PO1011
Dialysis in Life-Threatening Caffeine Toxicity
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Yaseen, Mustafa, Sunrise GME, Las Vegas, Nevada, United States
- Bennett, Elizabeth Warner, Tufts University, Medford, Massachusetts, United States
- Mahmoud, Hassan, MaineHealth, Portland, Maine, United States
Introduction
Caffeine ingestion is common with the widespread availability of the supplement, whether liquid or solid (e.g., pills, combined with food, etc.). Caffeine overdoses are increasingly common with data from US toxic centers showing the majority of cases occur in people under the age of 20. Unintentional overdoses are more common with solid formulations and in children less than 6 years old (Thompson et al., 2025). Conversely, intentional overdose is more common in adolescents and adults, with more severe outcomes.
Case Description
A 23 year old male with known depression and prior suicide attempts presented after intentional ingestion of 50 energy drinks (~ 10g of caffeine). He presented with emesis, seizure-like activity, urine and stool incontinence, and low GCS requiring intubation.
Labs showed hypokalemia (2.4 mmol/L), metabolic acidosis (15 mmol/L), elevated lactate peaking at 9 mmol/L, hypophosphatemia (<1 mg/dL), and CK (557 U/L). Creatinine was 0.94 mg/dl. EKG showed QTc prolongation (567 ms), with concern for ventricular arrhythmias on cardiac monitoring. Toxicology screening was negative.
During the 24 hours, urine output was at 3 liters. Hemodialysis was initiated with correction of acid-base status and electrolyte abnormalities. No further malignant arrhythmias were observed. He was extubated the following morning, with continued clinical stabilization.
Discussion
Treatment is guided by disease severity and secondary organ damage. This case highlights several indicators of severe overdose necessitating dialysis. These are seizure activity, hypokalemia and rapidly increasing lactic acidosis, with cardiac manifestations of toxicity (QTc prolongation and ventricular arrhythmias) (Ghannoum et al., 2015). All manifesting within hours of substance ingestion. Other indications include serum caffeine levels of >80mg/L (Kohl et al., 2020). These effects are dose-dependent and are mediated by adenosine receptor blockade, catecholamine release and intracellular calcium release (Mitomo et al., 2024) .
Kidney injury can result from several mechanisms, with catecholamine-induced renal vasoconstriction and/or rhabdomyolysis. While primarily metabolized by the liver through cytochrome P450, several characteristics allow caffeine to be dialyzed (Song et al., 2024) . The major ones are its small molecular volume size (MEFANET, Caffeine) , relatively low volume of distribution (0.5-0.75 L/kg) and low protein-binding (10-36%) (Reddy et al., 2024).
Acknowledgment
AI used to help with writing style but not used for any of the content/material