PMID- 38129271
OWN - NLM
STAT- MEDLINE
DCOM- 20240122
LR  - 20240201
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 76
DP  - 2024 Feb
TI  - Severe caffeine poisoning treated with intermittent hemodialysis under 
      circulatory support.
PG  - 270.e5-270.e7
LID - S0735-6757(23)00693-9 [pii]
LID - 10.1016/j.ajem.2023.12.014 [doi]
AB  - Caffeine poisoning can cause fatal ventricular arrhythmias. In this report, we 
      describe a case of severe caffeine poisoning with extraordinarily high blood 
      caffeine levels. Despite developing refractory ventricular fibrillation, the 
      patient was successfully treated with intermittent hemodialysis (IHD) under 
      circulatory support by venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO). A 22-year-old male was transported to our hospital approximately 2.5 h 
      after ingesting 200 highly caffeinated tablets (200 mg/tablet) (40 g caffeine 
      total) in a suicide attempt. On arrival, the patient vomited frequently with a 
      Glasgow Coma Scale score E3V2M5, heart rate 185 beats/min, and a blood pressure 
      of 97/62 mmHg. Shortly after arrival, the patient developed ventricular 
      fibrillation which was refractory either to three electrical defibrillations or 
      antiarrhythmic drugs, resulting in endotracheal intubation for mechanical 
      ventilation and VA-ECMO. Starting from 2 h after arrival, intermittent 
      hemodialysis (IHD) was performed for 11 h, which markedly improved clinical 
      symptoms and circulatory parameters. Serum caffeine level was 454.9 mg/dL upon 
      arrival at the hospital, but it decreased to 55.5 mg/dL by the end of IHD 
      treatment. Renal replacement therapy (RRT) including intermittent 
      hemodiafiltration, continuous hemodiafiltration, and IHD was continued because of 
      rhabdomyolysis with myoglobinuria and secondary caused acute kidney injury. The 
      patient was weaned off VA-ECMO on hospital day 7, extubated on hospital day 18, 
      weaned from RRT on hospital day 46, and was transferred to another hospital for 
      physical rehabilitation on hospital day 113. IHD under circulatory support by 
      VA-ECMO should be considered in severe caffeine poisoning causing potentially 
      fatal arrhythmias.
CI  - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Mitsui, Daichi
AU  - Mitsui D
AD  - Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 
      1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan. Electronic address: 
      sincostan5432@yahoo.co.jp.
FAU - Kamijo, Yoshito
AU  - Kamijo Y
AD  - Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, 
      Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan.
FAU - Yoshino, Takumi
AU  - Yoshino T
AD  - Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 
      1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan.
FAU - Hanazawa, Tomoki
AU  - Hanazawa T
AD  - Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, 
      Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan.
FAU - Yoshizawa, Tomohiro
AU  - Yoshizawa T
AD  - Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, 
      Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan.
FAU - Iwase, Fumiaki
AU  - Iwase F
AD  - Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 
      1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan.
LA  - eng
PT  - Case Reports
DEP - 20231212
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 3G6A5W338E (Caffeine)
SB  - IM
MH  - Male
MH  - Humans
MH  - Young Adult
MH  - Adult
MH  - Caffeine
MH  - Ventricular Fibrillation/chemically induced/therapy
MH  - *Cardiovascular System
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Arrhythmias, Cardiac
MH  - Renal Dialysis
OTO - NOTNLM
OT  - Caffeine poisoning
OT  - Renal replacement therapy
OT  - Veno-arterial extracorporeal membrane oxygenation
OT  - Ventricular fibrillation
COIS- Declaration of Competing Interest None.
EDAT- 2023/12/22 00:42
MHDA- 2024/01/22 06:42
CRDT- 2023/12/21 22:01
PHST- 2023/07/22 00:00 [received]
PHST- 2023/12/07 00:00 [revised]
PHST- 2023/12/09 00:00 [accepted]
PHST- 2024/01/22 06:42 [medline]
PHST- 2023/12/22 00:42 [pubmed]
PHST- 2023/12/21 22:01 [entrez]
AID - S0735-6757(23)00693-9 [pii]
AID - 10.1016/j.ajem.2023.12.014 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2024 Feb;76:270.e5-270.e7. doi: 10.1016/j.ajem.2023.12.014. Epub 
      2023 Dec 12.