\s=b\To our knowledge, the clinical course of acute caffeine poisoning in neonates has not been previously reported. Three full-term infants manifested CNS irritability after the parenteral administration of large doses of caffeine and benzoate sodium injection in the delivery room for respiratory depression. The infants received caffeine in doses that ranged from 36 to 136 mg/kg. On arrival in a regional newborn center, they exhibited one or more of the following symptoms: tachypnea, fine tremor of the extremities, opisthotonus, tonic-clonic movements, and nonpurposeful jaw and lip movements. The overdose of caffeine produced a clinical picture that suggested neonatal seizures and prompted therapy with anticonvulsants. A fourth infant (premature) attained a high plasma caffeine concentration, but this infant's symptoms were altered by intraventricular hemorrhage.The combination of caffeine overdose and perinatal asphyxia may precipitate or increase seizure activity in the neonate. Recognition of the potential toxic effects of caffeine overdose should guide patient care and stimulate further study to establish appropriate use of caffeine in the newborn infant.(Am J Dis Child 134: [495][496][497][498] 1980) Although acute caffeine poisoning -1 . in adults has been reported since 1883, the effects of caffeine overdose in newborn infants are apparently unrecorded in the medical literature.Caffeine and other methylxanthines, such as theophylline and theobromine, have many effects, including diuresis, smooth muscle relaxation, skeletal muscle stimulation, myocardial stimu¬ lation, and CNS stimulation. The stimulation of the medullary respira¬ tory center increases the rate and depth of respiration and sensitizes this center to carbon dioxide.2 This effect has been exploited in the treat¬ ment of apnea of prematurity. Both theophylline and caffeine are useful in the management of recurrent epi¬ sodes of apnea, when underlying pathology has been excluded.34Neonatal exposure to caffeine oc¬ curs as a result of maternal transmission through breast milk"' and from therapeutic use in the delivery room or nursery. Even though the use of caffeine in the delivery-room manage¬ ment of apnea seems limited and con¬ troversial, a contemporary textbook of neonatology" states that caffeine is "well tolerated ...[and] large doses may be given without serious ill effects."We studied four neonatal cases of caffeine poisoning after administra¬ tion of an injectable preparation of caffeine. After the diagnosis of caf¬ feine poisoning in the index patient, three additional cases were discovered during a three-week surveillance of admissions to the local newborn cen¬ ter. Plasma caffeine concentrations were measured in three patients with a previously described high pressure liquid Chromatographie assay adapted for caffeine.7 REPORT OF CASESCase 1.-The patient was a 2,660-g, fullterm girl born to an 18-year-old primagravida. The pregnancy was uneventful and labor was spontaneous. Delivery was com¬ plicated by cephalopelvic disproportion...

The effect of a saline cathartic combined with activated charcoal or activated charcoal alone on aspirin bioavailability was characterized in six healthy volunteers. Using a random, Latin-square design, subjects were given 975 mg aspirin followed by either water alone, 15 Gm activated charcoal (AC), or 15 Gm activated charcoal plus 20 Gm sodium sulfate (AC + SS) separated by one week. Both AC (44.16 +/- 16.85 microgram/ml) and AC + SS (58.61 +/- 10.63 microgram/ml) decreased (P less than 0.001) the maximal plasma salicylate concentration (Cpmax) compared to control (86.61 +/- 12.69 microgram/ml). Urinary salicylate recovery was decreased (P less than 0.01) for AC (57.88 +/- 16.26 per cent) and AC + SS (61.00 +/- 11.49 per cent) as compared to control (93.73 +/- 6.83 per cent), while for area under the plasma concentration-time curve (AUC) only AC showed a decrease (P less than 0.01) compared to control. Neither AC nor AC + SS differed from each other for Cpmax, AUC, or cumulative urinary recovery. Our findings indicate that the addition of sodium sulfate to activated charcoal has no added effect on limiting aspirin adsorption relative to activated charcoal alone.

We report detailed measurements of the Onsager-like planar thermal Hall conductivity κxy in α-RuCl3, a spin-liquid candidate of topical interest. With the thermal current JQ and magnetic field B a (zigzag axis), the observed κxy/T varies strongly with temperature T (1-10 K). The results are well-described by bosonic edge excitations which evolve to topological magnons at large B. Fits to κxy/T yield a Chern number ∼ 1 and a band energy ω1 ∼1 meV, in agreement with sharp modes seen in electron spin-resonance experiments. The bosonic character is incompatible with half-quantization of κxy/T .

Despite the indications of previous case reports and standard references, peritoneal dialysis did not appreciably enhance the elimination of phenytoin in our patient. In view of our observations, the effectiveness of peritoneal dialysis for phenytoin poisoning should be seriously questioned. A careful reassessment of the efficiency of peritoneal dialysis for phenytoin should be performed and should consider the possible role of phenytoin metabolites contributing to toxicity. Until well-controlled studies support the use of any dialytic procedure for phenytoin overdosage, the management of these patients must rely on general measures to minimize absorption of the drug and on supportive treatment as indicated by the patient's condition.