Intralipid and haemodialysis in caffeine overdose

Abstract

A 26-year-old woman presented after an intentional ingestion of 20 g of caffeine. She suffered a profound respiratory alkalosis with metabolic acidosis, hypokalaemia and sustained polymorphic ventricular tachycardia. She was treated with intravenous intralipid and haemodialysis, and her arrhythmia was controlled using magnesium sulphate. Once invasively ventilated and unable to hyperventilate the patient became acidotic and required intravenous bicarbonate to correct her acid–base status. Two days following the overdose the patient was extubated, haemodialysis was stopped and norepinephrine was weaned off. The patient was discharged after a further 7 days. Serial caffeine levels were taken during this patient’s care; the highest measured caffeine concentration 7 hours after ingestion was 147.1 mg/L. The known lethal dose of caffeine is 80 mg/L. Intralipid and haemodialysis represent a new and viable treatment in life-threatening caffeine overdose. Intravenous magnesium may terminate unstable arrhythmias in caffeine-poisoned patients.

Caffeine Intoxication: Unregulated, Over-the-Counter Sale of Potentially Deadly Supplements

“…However, if the said physiopathological effect is considered, labetalol is preferred in the deterrence of propranolol due to α and β block. Electrolytic imbalances should be aggressively treated, as they may contribute to cardiac electrical instability [14]. Lipid emulsion and dialysis may aid in the management of these patients, rapidly removing the toxic and correcting hydroelectrolytic imbalances [14,15].…”

“…Electrolytic imbalances should be aggressively treated, as they may contribute to cardiac electrical instability [14]. Lipid emulsion and dialysis may aid in the management of these patients, rapidly removing the toxic and correcting hydroelectrolytic imbalances [14,15].…”

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

“…Intravenous lipid emulsion is proposed to act by removing of caffeine molecules (an amphiphilic substance) from target organs such as the heart and brain; the so-called “lipid sink.” acting by removal of caffeine molecules (amphiphilic substance) from target organs such as the heart and brain [ 17 , 37 , 41 , 43 ].…”

“…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 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.…”