Caffeine overdose
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Various toxicities following drug overdose in a suicide attempt: case report An 18-year-old man developed anxiety, emesis, nausea, diaphoresis, sinus tachycardia, tachypnoea, prolonged QTc, restless, increased lactic acid levels and drug toxicity following an intentional overdose of caffeine in a suicide attempt. The man presented to the emergency department following the ingestion of caffeine in an overdose. He reported ingesting 100 caffeine pills (each pill of 200mg) in a suicide attempt 45 minutes prior to the presentation. On arrival, he experienced emesis with associated nausea and anxiety. His initial vital signs showed: temperature 36.3°C, BP of 116/61mm Hg, HR of 143 beats/min, SpO2 92% on room air and RR of 31 breaths/min. During examinations, he was noted as anxious and diaphoretic. His pupils were 3mm and were responsive bilaterally. Further examinations showed a soft, non-tender abdomen, tachypnoea and tachycardia. Neurologically, he was restless with no gross motor deficits. Psychiatric evaluation demonstrated suicidal ideation and depression with intact judgment. After consultation with toxicology, the man’s treatment was started with activated charcoal administered via nasogastric tube on the basis of his time of presentation in relation to the toxic ingestion. Additionally, he received only supportive treatment including normal saline administration. ECG showed sinus tachycardia with a prolonged QTc of 447ms. Laboratory examinations showed potassium of 3.0 mEq/L, lactic acid of 8.1 mEq/L, ethanol level of 71 mg/dL and an anion gap of 23. His caffeine level was found to be >100 mg/L (which was the testing limit). Repeat test showed lactate of 7.9 mEq/L. He was then shifted to the Medical ICU. Fortyeight hours after the presentation, repeat test for caffeine level was found as 32 mg/L with a normal lactate level. Thereafter, he was transferred to the Psychiatry service, where he was started on cognitive behavioural therapy, escitalopram and buspirone. Following a 6-day hospitalisation, he was no longer suicidal and was discharged with outpatient psychiatry follow-up. Meester S, et al. Consider Going Decaf: An Intentional Caffeine Overdose in the Emergency Department. Journal of Emergency Medicine 2020: 20 Oct 2020. Available from: 803514444 URL: http://doi.org/10.1016/j.jemermed.2020.09.024
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Reactions 14 Nov 2020 No. 1830
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