A 54-year-old woman with a history of excess weight and active smoking presented to the emergency department (ED) due to syncope after a long flight. She reported a similar episode in the previous month, which had also occurred after a long air voyage. She presented with hypotension, dehydration, and hyperlactacidemia. The clinical team ruled out acute coronary syndrome, pulmonary embolism, and cerebrovascular accident. After clinician insistence, she reported having ingested anhydrous caffeine, an over-the-counter diuretic usually used by individuals seeking to lose weight, and a diagnosis of caffeine intoxication was made. The overthe-counter sale of this apparently innocuous substances is a rising phenomenon, and physicians should be aware of the signs of its ingestion.

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