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Katsuki H, Kamijo Y, Kyan R, Abe H. The efficacy of intermittent hemodialysis in severe bromovalerylurea poisoning. Am J Emerg Med 2024; 79:231.e1-231.e2. [PMID: 38521712 DOI: 10.1016/j.ajem.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
Bromvalerylurea (BVU) is a sedative-hypnotic drug with a high risk of acute poisoning. In the present case, hemodialysis (HD) was introduced in a patient with severe BVU poisoning who later demonstrated respiratory arrest, and then HD clearances (CLHD) were assessed in detail. A 20-year-old female was transported to the emergency department by ambulance, an estimated two to four hours after orally ingesting 144 tablets of Utto® (12,000 mg BVU) in a suicide attempt. The patient was comatose on arrival. After intratracheal intubation, 50 g of activated charcoal was administered through nasogastric tube. She was then transferred to the intensive care unit. Ten hours after arrival at the hospital, her light reflex, contralateral light reflex, corneal reflex, and spontaneous respiration disappeared, resulting in an introduction of HD 16 h after arrival. Eighteen hours after arrival, her light reflex, contralateral light reflex, and corneal reflexes had recovered. Twenty-one hours after arrival, her consciousness level improved and the patient was weaned from HD. During HD treatment, blood samples were collected pre-HD and post-HD every hour. Serum BVU concentrations were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The median CLHD was 133.61 mL/min, and the systemic clearance (CLSYS) was 117.77 mL/min. Higher CLHD of BVUs over CLSYS suggests that HD may play an important role in the treatment of severe BVU poisoning.
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Affiliation(s)
- Hironori Katsuki
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan; Emergency and Critical Care Center, Iizuka Hospital, 3-38, Yoshiomachi, Iizukashi, Fukuoka 820-0018, Japan.
| | - Yoshito Kamijo
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan
| | - Ryoko Kyan
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan
| | - Hiroko Abe
- Emergency and Critical Care Center, Iizuka Hospital, 3-38, Yoshiomachi, Iizukashi, Fukuoka 820-0018, Japan; Bio Design Inc, 3-25-15, Nishiikebukkuro, Toyoshimaku, Tokyo 171-0021, Japan
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Mitsui D, Kamijo Y, Yoshino T, Hanazawa T, Yoshizawa T, Iwase F. Severe caffeine poisoning treated with intermittent hemodialysis under circulatory support. Am J Emerg Med 2024; 76:270.e5-270.e7. [PMID: 38129271 DOI: 10.1016/j.ajem.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Caffeine poisoning can cause fatal ventricular arrhythmias. In this report, we describe a case of severe caffeine poisoning with extraordinarily high blood caffeine levels. Despite developing refractory ventricular fibrillation, the patient was successfully treated with intermittent hemodialysis (IHD) under circulatory support by venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 22-year-old male was transported to our hospital approximately 2.5 h after ingesting 200 highly caffeinated tablets (200 mg/tablet) (40 g caffeine total) in a suicide attempt. On arrival, the patient vomited frequently with a Glasgow Coma Scale score E3V2M5, heart rate 185 beats/min, and a blood pressure of 97/62 mmHg. Shortly after arrival, the patient developed ventricular fibrillation which was refractory either to three electrical defibrillations or antiarrhythmic drugs, resulting in endotracheal intubation for mechanical ventilation and VA-ECMO. Starting from 2 h after arrival, intermittent hemodialysis (IHD) was performed for 11 h, which markedly improved clinical symptoms and circulatory parameters. Serum caffeine level was 454.9 mg/dL upon arrival at the hospital, but it decreased to 55.5 mg/dL by the end of IHD treatment. Renal replacement therapy (RRT) including intermittent hemodiafiltration, continuous hemodiafiltration, and IHD was continued because of rhabdomyolysis with myoglobinuria and secondary caused acute kidney injury. The patient was weaned off VA-ECMO on hospital day 7, extubated on hospital day 18, weaned from RRT on hospital day 46, and was transferred to another hospital for physical rehabilitation on hospital day 113. IHD under circulatory support by VA-ECMO should be considered in severe caffeine poisoning causing potentially fatal arrhythmias.
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Affiliation(s)
- Daichi Mitsui
- Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan.
| | - Yoshito Kamijo
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan
| | - Takumi Yoshino
- Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan
| | - Tomoki Hanazawa
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan
| | - Tomohiro Yoshizawa
- Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan
| | - Fumiaki Iwase
- Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan
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Severe caffeine poisoning successfully treated with high flow continuous hemodialysis: A case report. Am J Emerg Med 2022; 58:351.e3-351.e5. [DOI: 10.1016/j.ajem.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
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Hanazawa T, Kamijo Y, Yoshizawa T, Usui K. Rapid measurement of serum caffeine concentrations in acuteclinical settings. TOXICOLOGY COMMUNICATIONS 2021. [DOI: 10.1080/24734306.2021.1928366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Tomoki Hanazawa
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Saitama, Japan
- Department of General Internal Medicine, Fujimi Hospital, Itabashi, Tokyo, Japan
| | - Yoshito Kamijo
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Tomohiro Yoshizawa
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Kiyotaka Usui
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Saitama, Japan
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Yoshizawa T, Kamijo Y, Hanazawa T, Usui K. Criterion for initiating hemodialysis based on serum caffeine concentration in treating severe caffeine poisoning. Am J Emerg Med 2021; 46:70-73. [PMID: 33735699 DOI: 10.1016/j.ajem.2021.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Tomohiro Yoshizawa
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Iruma-gun, Saitama, Japan.
| | - Yoshito Kamijo
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Iruma-gun, Saitama, Japan
| | - Tomoki Hanazawa
- Emergency Center and Poison Center, Saitama Medical University Hospital, Moroyama, Iruma-gun, Saitama, Japan
| | - Kiyotaka Usui
- Department of Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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