Issn Print: 0090-3493
Publication Date: 2004/12/01
MULTIPLE CARDIAC ARRESTS FOLLOWING A CAFFEINE OVERDOSE COMPLICATED BY PENETRATING TRAUMA: 667
Osa Emohare; Valli Ratnam
Excerpt
Overdoses of caffeine can produce life threatening complications. Although the simple cardiovascular effects are well documented, adverse events can occur in other systems A 28 year old male presented to the emergency department following a suicide attempt, having ingested 350 tablets of a caffeine based stimulant(17.5g of caffeine) 90 minutes earlier. He had smoked an unspecified amount of marijuana, after which he shot himself in the head with a handgun. GCS on admission was 14, BP was 80/60 mm/Hg. He was in sinus tachycardia at a rate of 110. Auscultation of his chest was normal. A blood gas analysis on an FIO2 of 0.5 showed a pH of 6.797, pCO2 of 4.45, pO2 of 68.24kPa, HCO3 of 5, a base excess of -29.0 and a K+ of 2.46 mmol/L. Random glucose was 18.7 mmol/L and Lactate was 21.25 mmol/L. CT scanning of his head was performed to locate the projectile. Subsequent to this, the patient developed ventricular fibrillation, requiring defibrillation. He reverted to sinus rhythm, but over the course of the next hour required 1 minute of cardiopulmonary resuscitation and had five further episodes of ventricular fibrillation, each punctuated by episodes of pulseless electronic activity. He was transferred to the ICU, where 24 hours into his admission he developed rhabdomyolysis, with creatinine kinase peaking at 28,352 IU/L. On his second hospital day, he was extubated uneventfully. Stereotactic removal of the projectile followed at a tertiary center. It is important to be aware of the range of substances that can be implicated in overdose. An important consideration with caffeine is the fact that it is completely and rapid-ly absorbed, with plasma concentration peaking between 5 and 90 minutes after ingestion. Most of its life threatening features are seen in the first few hours following ingestion. Support and therapeutic input should therefore be maximal in the early stage. An anticipatory approach is paramount as caffeine overdoses can pose a unique physiological conundrum.
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