Dangerous mistake: an accidental caffeine overdose

Development of a simple estimation method of serum caffeine concentration using a point-of-care test kit for urinary caffeine

PURPOSE

Serum caffeine concentration is an indicator of caffeine intoxication; however, it is difficult to measure it in most emergency departments. We developed a simple estimation method using a point-of-care test kit for urinary caffeine.

METHODS

Caffeine-spiked human serum (100, 50, 25, and 10 µg/mL) was diluted 10-, 20-, 50-, and 100-fold with phosphate-buffered saline and applied to the kit. After 5 min incubation, the kit was scanned by a flatbed scanner and the membrane image was processed with ImageJ.

RESULTS

When the 20-fold diluted serum was applied, serum samples with initial caffeine concentration ≤ 25 and ≥ 50 µg/mL were caffeine-negative and -positive, respectively. When the 100-fold diluted serum was applied, none of the caffeine-spiked serum samples gave positive results. Therefore, we proposed the following test procedure: (i) 20-fold diluted serum was initially tested and (ii) 100-fold diluted serum was additionally tested when the initial result was caffeine positive. Using this procedure, caffeine concentration is expected to be classified into three levels: ≤ 25, > 25- ≤ 100, and > 100 µg/mL, which almost correspond to no or mild, severe, and potentially fatal intoxication, respectively. The test procedure was validated using postmortem heart blood from two cases of fatal caffeine intoxication (caffeine concentration: 276 and 175 µg/mL) and two cases of other intoxication.

CONCLUSIONS

Our developed method using point-of-care urinary caffeine test kits enabled simple estimation of serum caffeine concentration.

Successful Use of Continuous Veno-Venous Haemodialysis in a Case of Potential Lethal Caffeine Intoxication

Here we describe the case of a potentially lethal caffeine intoxication after the reported ingestion of 10 g of caffeine. Due to hemodynamic instability with tachycardia and hypertension with an insufficient effect of continuous labetalol infusion, the patient was started on continuous veno-venous haemodialysis (CVVHD). After successful treatment for 15 h, CVVHD could be discontinued, and the patient was discharged home the next day. This case report is the first to report the use of CVVHD as a haemodialysis modality in the case of caffeine intoxication and illustrate the effect on caffeine clearance. We stress the importance of an early recognition of caffeine intoxication, so that haemodialysis can be considered in the case of a potentially lethal intoxication.

Comparison between the American and the European Systems of Monitoring Adverse Effects of Dietary Supplements and Their Usefulness on the Polish Market

Many Polish patients do not inform physicians about supplements they use in addition to prescribed medicines. This may be because they consider dietary supplements as being rather natural products that cannot cause health problems. Although dietary supplements may produce side effects, Poland's food safety system and medical statistics do not recognise the necessity of reporting such cases. However, a different approach is observed in France and the United States where adverse effects of food supplements as well as drugs are reported. The aim of this study was to determine the need for creating in Poland a general model of a register monitoring dietary supplements and their adverse effects. In order to achieve this goal, a detailed comparison between the American and European monitoring systems was made. It showed the relationship between negative symptoms caused by specific components in supplements and t profiles of patients who reported side effects. Additionally, it was found that there is a real risk associated with side effects caused by dietary supplements. Therefore, it necessary to establish in Poland a special system for recording such cases as it should be beneficial to patients, including polypragmatic patients.

Analysis of vaporized caffeine in smoke from e-cigarettes using liquid chromatography-tandem mass spectrometry and clarification of minor components

PURPOSE

Electronic cigarettes (e-cigarettes) are used widely, and e-cigarettes containing caffeine (Caf) have recently become commercially available. However, no risk evaluation of these Caf-containing products has been performed to date. Such an evaluation requires a sensitive analytical method for quantifying Caf in smoke from e-cigarettes. The aim of this study was to establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for quantifying vaporized Caf from commercially available e-cigarettes, and to determine minor components related to Caf in cigarette smoke extract (CSE).

METHODS

A sampling system for Caf using a suction pump was designed and sampling conditions were optimized.

RESULTS

The optimized LC-MS/MS conditions allowed the sensitive determination of Caf in smoke with a limit of detection of 0.03 ng/mL at a signal-to-noise ratio of 3. The method was applied to CSEs from five e-cigarette products and the concentration of Caf ranged from 0.894 ± 0.090 to 3.32 ± 0.14 μg/mL smoke (n = 3). Additionally, minor components related to Caf, such as theobromine, theophylline, and paraxanthine, were detected in CSE and in e-liquid at very low concentrations, indicating that they were impurities in e-liquid and vaporized along with Caf.

CONCLUSION

This is the first report to determine the concentration of vaporized Caf using an LC-MS/MS method and to clarify several minor components in smoke from e-cigarettes.

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

Caffeine, chemically 1,3,7-trimethylxanthine, is the most widely consumed central nervous system stimulant in the world with pleiotropic effects on the cardiovascular, pulmonary, and renal systems. The advent of over the counter (OTC) caffeine formulations has opened the window for potential toxicity, either by inadvertent or intentional overdosing. We present the case of a patient who attempted suicide by caffeine overdose treated with emergent haemodialysis and a review of the literature.

Serotonin Syndrome Triggered by Overuse of Caffeine and Complicated With Neuroleptic Malignant Syndrome: A Case Report

Serotonin syndrome is a rare complication occurring in patients with psychiatric disorders that are treated with selective serotonin reuptake inhibitors (SSRIs). There are various triggers for serotonin syndrome, including non-SSRI antidepressants. In rare cases, serotonin syndrome may be triggered by nonmedicinal foods, such as coffee. The patient described in this case report was a 65-year-old woman with a past medical history of major depression and a diagnosis of Parkinson’s disease who presented to our medical center with chief complaints of nausea, vomiting, and drowsiness. She had previously been prescribed paroxetine hydrochloride hydrate for depression, and she was prescribed levodopa and carbidopa for Parkinson’s disease. She also drank 20 cups of coffee in a short period of time two days prior to admission due to excessive sleepiness. She was diagnosed with serotonin syndrome based on her clinical symptomology, which included diaphoresis, mydriasis, fine tremor, myoclonus, hypertension, and tachycardia. She was treated with diazepam and cyproheptadine hydrochloride hydrate. Later, she experienced muscle pain with increased creatinine kinase levels after she failed to take levodopa and carbidopa. These findings were suggestive of neuroleptic malignant syndrome. The patient was treated with supportive care. Excessive coffee intake triggers serotonin syndrome by promoting 5-hydroxytryptamine (serotonin) secretion. Patients with psychiatric diseases that necessitate treatment with SSRIs should be educated regarding caffeine consumption. Moreover, patients presenting with agitation and drowsiness should be evaluated for serotonin syndrome within the differential diagnosis. Patients with depression and Parkinson’s syndrome should be evaluated for associated comorbidities, particularly serotonin syndrome and neuroleptic malignant syndrome.

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

Caffeine is an integral part of beverages, food, and medications. Severe intoxication of caffeine is rare, and reports are even scarcer. However, over-the-counter, unregulated sale of performance-enhancing compounds, such as caffeine, turns high-dose consumption into a real concern. Severe intoxication may be fatal, usually by malignant cardiac arrhythmia. We report a case of a 23-year-old university student who accidentally consumed about 100 times the amount present in an expresso of anhydrous caffeine.

Flying From Hospital to Hospital: A Case of Caffeine Intoxication

A 54-year-old woman with a history of excess weight and active smoking presented to the emergency department (ED) due to syncope after a long flight. She reported a similar episode in the previous month, which had also occurred after a long air voyage. She presented with hypotension, dehydration, and hyperlactacidemia. The clinical team ruled out acute coronary syndrome, pulmonary embolism, and cerebrovascular accident. After clinician insistence, she reported having ingested anhydrous caffeine, an over-the-counter diuretic usually used by individuals seeking to lose weight, and a diagnosis of caffeine intoxication was made. The over-the-counter sale of this apparently innocuous substances is a rising phenomenon, and physicians should be aware of the signs of its ingestion.