A Retrospective Study on the Epidemiological and Clinical Features of Emergency Patients with Large or Massive Consumption of Caffeinated Supplements or Energy Drinks in Japan

Abstract

Objective We conducted a retrospective study on the epidemiological and clinical features of patients with acute caffeine poisoning in Japan. Methods Letters requesting participation were sent to 264 emergency departments of hospitals, and questionnaires were mailed to those that agreed to participate. Patients Participants were patients transported to emergency departments of hospitals between April 2011 and March 2016 after consuming large or massive amounts of caffeinated supplements and/or energy drinks (caffeine dose ≥1.0 g). Results We surveyed 101 patients from 38 emergency departments. Since April 2013, the number of patients has markedly increased. Of these young patients (median age, 25 years), 53 were men, and 97 had consumed caffeine in tablet form. Estimated caffeine doses (n=93) ranged from 1.2 to 82.6 g (median, 7.2 g). Serum caffeine levels on admission (n=17) ranged from 2.0 to 530.0 μg/mL (median level, 106.0 μg/mL). Common abnormal vital signs and laboratory data on admission included tachypnea, tachycardia, depressed consciousness, hypercreatinekinasemia, hyperglycemia, hypokalemia, hypophosphatemia, and hyperlactatemia. Common signs and symptoms in the clinical course included nausea, vomiting, excitement/agitation, and sinus tachycardia. Seven patients (6.9%) who had consumed ≥6.0 g of caffeine, or whose serum caffeine levels on admission were ≥200 μg/mL, developed cardiac arrest. Ninety-seven patients (96.0%) recovered completely, but 3 patients (3.0%) died. Conclusion The present analysis of data from more than 100 emergency patients revealed clinical features of moderate to fatal caffeine poisoning. We recommend highlighting the toxicity risks associated with ingesting highly caffeinated tablets.

Caffeine content of pre‐workout supplements commonly used by Australian consumers

“…While this result was somewhat anticipated (products promote the presence of caffeine), approximately half the PWS products investigated appeared likely to expose consumers to potential caffeine‐related harms. Recent public health recommendations for caffeine (eg, single doses <200 mg and daily consumption <400 mg (except pregnant women) reflect concerns over the increased availability of caffeinated products (eg, energy drinks) and increases in the frequency of caffeine‐related adverse events (including sleeping disturbance, anxiety, cardiovascular events, seizures, and death) . While no published evidence is available indicating the prevalence of PWS‐derived adverse events, anecdotally, the popularity and diversity of PWS continues to increase and recent case reports of adverse events linked to PWS consumption raise concern .…”

Pill-induced esophagitis caused by ingesting excessive caffeine tablets

“…Presumably, pills do not injure the esophagus directly if they pass rapidly through esophagus into the stomach. A previous report reported that 97 of 101 patients with acute caffeine intoxication in Japan had consumed caffeine in tablet form [1]. Therefore, patients in Japan are at a high risk of caffeineinduced acute esophageal damage.…”

“…Caffeine tablets are sold as over-the-counter supplements, and they are thought to be safe when consumed according to the manufacturers' instructions (less than 500 mg/day) [24]. However, acute caffeine intoxication has been occurring more frequently than previously in Japan, as well as in other countries, due to excessive caffeine ingestion (2 g or more) [1,24]. Plasma caffeine concentrations of more than 80-200 mg/L are considered lethal [24][25][26].…”

“…Because caffeine is readily accessible and a caffeine overdose can cause death, the substance is used in suicide attempts. Kamijo et al analyzed 101 patients from 38 emergency departments in Japan, between April 2011 and March 2016, after ingesting an overdose of caffeine [1]. The authors reported that seven patients experienced cardiac arrest, three of which died.…”

Caffeine Overdose Complicated by Acute Kidney Injury despite Mild Creatine Kinase Elevation

“…Caffeine is a natural alkaloid that is obtained from coffee beans, tea leaves, cocoa beans, and kola nuts [1, 2]. It is included in drinks, prescription, and over-the-counter drugs, as well as weight loss supplements [2].…”