Successful treatment of acute caffeine intoxication with hemodialysis

Abstract

Keywords： caffeine, intoxication, lethal dose, hemodialysis, overdose 〈Abstract〉 Caffeine is a readily available drug that is used to prevent sleepiness in Japan. However, severe caffeine intoxication can be fatal. Only a few cases of severe caffeine intoxication have been reported in Japan. We report a case involving a 32-year-old female with active suicidal thoughts, who visited our hospital after consuming 240 caffeine tablets, each of which contained 24 g of caffeine. The day after she took the pills, she visited our hospital complaining of sustained nausea and tremors. She was suffering from excessive perspiration and eyelid spasms, hypertonia, and tremors on arrival. Her electrocardiogram revealed sinus tachycardia and premature ventricular contractions. Hypokalemia and an acid-base balance disorder were detected during a blood test performed on arrival. She was immediately treated with hemodialysis for 4 hours, which resulted in the rapid disappearance of the premature ventricular contractions, tachycardia, and other symptoms of caffeine poisoning. After one hemodialysis session, the patient's blood caffeine concentration had decreased to 13.9 mg/L from 49.4 mg/L, and her blood caffeine level became undetectable within 24 hours after her arrival. Caffeine is the most commonly used drug that stimulates the sympathetic nerve system worldwide. The number of caffeine poisonings resulting from overdoses has recently increased in Japan. Many treatments have been employed for caffeine poisoning, but no effective treatment has been found. The volume distribution of caffeine ranges from 0.6-0.8 L/kg, its plasma protein binding value is 36%, and its molecular weight is 194, so hemoadsorption and 田島 恵莉香 北里大学北里研究所病院腎臓内科 〒 108-8642 東京都港区白金 5-9-1 Erika Tajima Tel ： 03-3444-6161 Fax： 03-5791-6318 〔受付日：2019 年 2 月 16 日，受理日：2019 年 9 月 10 日〕