Extracorporeal Membrane Oxygenation for Hypokalemia and Refractory Ventricular Fibrillation Associated with Caffeine Intoxication

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

“…Caffeine poisoning is frequently refractory, and hemodialysis is reported to be effective for lowering blood caffeine levels. 2 Caffeine has a protein binding rate of 36%, a molecular weight of 194, and a volume of distribution of 0.6-0.8 L/kg, which is relatively low, thereby increasing the effectiveness of hemadsorption and hemodialysis. The most common cause of death from caffeine poisoning is lethal arrhythmia, which persists until blood caffeine levels decrease.…”

Severe Caffeine Intoxication Treated With Hemodialysis: A Case Report

“…Few case reports demonstrate the use of HD, hemoperfusion, and/or continuous venovenous hemodiafiltration therapies for the treatment of caffeine intoxications. 15 , 16 , 17 In one report, an initial 4-hour HD session was successful in reducing caffeine levels by 66%, but the patient was hemodynamically unstable and subsequently transitioned to continuous hemodiafiltration. 5 In our case, 1 session of intensive prolonged HD contributed to increasing and expediting the elimination of caffeine in a patient with ingestion of a potentially toxic dose.…”

The successful use of extracorporeal membrane oxygenation combined with continuous renal replacement therapy for a cardiac arrest patient with refractory hypokalemia and diabetic ketoacidosis

“…[8] When DKA patients develop fatal dysrhythmia or even cardiac arrest induced by severe hypokalemia, ECMO could maintain circulation and provide time to correct electrolyte imbalances, while continuous renal replacement therapy (CRRT) could be used to restore homeostasis. [9,10] We report a case of a young male with DKA complicated with refractory hypokalemia, malignant arrhythmia and cardiac arrest. After failing to reverse his hypokalemia by providing potassium chloride intravenously in a short time and conventional organ support therapy, veno-arterial (VA)-ECMO combined with CRRT was performed.…”