TY - JOUR T1 - Intralipid and haemodialysis in caffeine overdose JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-234256 VL - 13 IS - 5 SP - e234256 AU - Rebecca Harsten AU - Simon John Tetlow AU - Torbert Chan AU - Akshaya Ankuli Y1 - 2020/05/01 UR - http://casereports.bmj.com/content/13/5/e234256.abstract N2 - 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. ER -