Article Text

Download PDFPDF
Case report
Intralipid and haemodialysis in caffeine overdose
  1. Rebecca Harsten,
  2. Simon John Tetlow,
  3. Torbert Chan and
  4. Akshaya Ankuli
  1. Critical Care, Queen Elizabeth Woolwich, London, UK
  1. Correspondence to Dr Rebecca Harsten; rebecca.harsten{at}nhs.net

Abstract

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.

  • arrhythmias
  • cardiovascular system
  • poisoning
  • adult intensive care
  • toxicology
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors RH managed the patient, conceived the case report, collected and analysed patient data, and authored the report. SJT managed the patient, collected and analysed patient data, and authored the report. TC managed the patient, collected patient data and provided editorial support for the manuscript. AA managed the patient, collected patient data and provided editorial support for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.