Caffeine poisoning successfully treated by venoarterial extracorporeal membrane oxygenation and emergency hemodialysis

Abstract

Background: Caffeine overdose can cause life-threatening circulatory failure, neurological abnormalities, and ventricular fibrillation.We report the case of a patient with caffeine poisoning who was successfully treated with early hemodialysis and venoarterial extracorporeal membrane oxygenation.Case Presentation: A 43-year-old man who had ingested pills containing 20 g caffeine was transported to the hospital 100 min after ingestion. Hemodynamic collapse and refractory arrhythmia were most likely the potential complications. The patient developed ventricular fibrillation when placed in the left lateral decubitus position. Return of spontaneous circulation with defibrillation and introduction of venoarterial extracorporeal membrane oxygenation were followed by emergency dialysis, which led to rapid improvement in the clinical findings. Conclusion:Acute caffeine poisoning in a patient who developed an arrhythmia was successfully treated using an indwelling arterial and venous sheath followed by venoarterial extracorporeal membrane oxygenation.

Treatment of Lethal Caffeine Overdose with Haemodialysis: A Case Report and Review

“…Multiple arrhythmias were reported including sinus tachycardia, supraventricular tachycardia [ 25 , 30 , 39 , 42 , 44 ], bradycardia and 3 rd degree AV block [ 25 ], PVCs and bigeminy [ 42 ], ventricular tachycardia [ 31 , 36 , 37 , 43 , 44 ], Torsades des pointes [ 37 , 41 ], and ventricular fibrillation [ 25 , 26 , 33 , 35 , 37 , 41 ].…”

“…The use of veno-arterial ECMO (i.e., VA-ECMO) in patients with severe drug overdose and profound cardiac toxicity has been also reported with positive results. It allows an increase in mean arterial pressure to permit the concomitant use of haemodialysis in patients with caffeine toxicity [ 35 , 41 , 44 ].…”

“…The first case of caffeine toxicity we found in our review of the literature treated with hemoperfusion was by Zimmerman et al, in the 1980s [25]. Since then, many others have described the use of several dialysis techniques in the management of acute caffeine intoxication [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. In the reported cases the most common acid base disorder was metabolic acidosis with elevated lactic acid.…”

Extracorporeal membrane oxygenation in the forensic setting: A series of 19 forensic cases

“…Organizing pneumonia 1 The clinical indications for ECMO are wide ranging but include both acute and chronic conditions which have compromised the functioning of the cardiopulmonary system. Acute indications may include acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, aortic dissections, trauma, hypothermia, or intoxication/poisoning [13][14][15][16][17][18][19][20]. Chronic conditions include the use of ECMO as a bridge to heart and lung transplant, as well as for the treatment of pulmonary hypertension, chronic obstructive pulmonary disease, congenital heart disease, and chronic heart failure including hypertensive, ischemic, and valvular heart disease [21][22][23][24][25][26].…”

Pharmacokinetics of caffeine self-administered in overdose in a Japanese patient admitted to hospital

“…However, preemptive hemodialysis and advanced life support maneuvers, respectively, in cases of caffeine overdoses of 50 and 40 g in 39- and 19-year-old men, respectively, were successful [ 6 , 7 ]. Other recent suicide attempts involving caffeine overdose in which the patients’ severe intoxication was successfully treated have been reported [ 8 – 10 ]. The monitoring of plasma concentrations of caffeine over a wide dose range may be considered in clinical or emergency situations.…”