Caffeine toxicity: Difference between revisions
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**CV: Tachycardia and palpitations | **CV: Tachycardia and palpitations | ||
**HEENT: Tinnitus, “zig-zag” flashes of light | **HEENT: Tinnitus, “zig-zag” flashes of light | ||
**GI: | **GI: Abdominal pain, nausea/vomiting | ||
**Renal: Dehydration, | **Renal: Dehydration, | ||
**MSK: Muscle trembling or twitching | **MSK: Muscle trembling or twitching | ||
**Newborns: Whole-body tremors painful | **Newborns: Whole-body tremors, painful, swollen abdomen with nausea | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 00:06, 13 July 2016
Background
- Overdose is more common in young children
- Caffeine overdoses in adults are rare and typically require ingestion in excess of 5 g[1]
- Toxic levels are considered to be 150-200mg/kg[2]
Common Dosages by Type
| Type | Amount | Caffeine^ |
| Coffee, brewed | 1 cup | 100mg |
| Coffee, instant | 1 cup | 75mg |
| Tea | 1 cup | 50mg |
| Red Bull | 1 can | 80mg |
| Rockstar | 1 can | 160mg |
| Excedrin Migraine | 2 tabs | 130mg |
^Average caffeine content can vary[3][4]
Clinical Features
- Sympathomimetic[5]
- Delusions
- Paranoia
- Tachycardia
- Hypertension
- Hyperpyrexia,
- Diaphoresis
- Piloerection
- Mydriasis
- Hyper-reflexia
- Seizures
- Hypotension
- Dysrhythmias
- Additional symptoms[6]
- Neuro: Agitation, anxiety, excitement, or restlessness; confusion or delirium; seizures
- CV: Tachycardia and palpitations
- HEENT: Tinnitus, “zig-zag” flashes of light
- GI: Abdominal pain, nausea/vomiting
- Renal: Dehydration,
- MSK: Muscle trembling or twitching
- Newborns: Whole-body tremors, painful, swollen abdomen with nausea
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Workup
- With clear hx, no further w/u is indicated
- With AMS or ambiguous presentation consider:
- UA
- CBC
- Chemistry
- LFTs
- CXR
- Utox
- ECG
- Head CT
- ?Blood and urine cultures
- ?Ammonia level
- ?Tylenol/ASA level
- ?LP
- ?Serum Osm
- ?Coags
- ?TFTs
- ?Cortisol
- ?ABG/VBG
Management
Treatment varies by severity of presentation[7]
- Airway
- Intubation is needed for AMS or seizures
- Breathing
- Supplemental O2
- Ventilation
- Circulation
- IVF
- Vasopressors for refractory hypotension (Norepi vs phenylephrine)
- BB or CCB for tachycardia
- Benzodiazepines for agitation
- Treat hypokalemia and rhabdo
- Antiemetics as needed
- HD can be used in severe cases
- Consult Poison Control
Disposition
- Admit all clinically unstable patients, suicide attempts, or those with ambiguous diagnoses
See Also
External Links
References
- ↑ Kerrigan S, et al. Fatal caffeine overdose: two case reports. Forensic science international. 2005; 153(1):67-69.
- ↑ Peters JM. Factors Affecting Caffeine Toxicity: A Review of the Literature. The Journal of Clinical Pharmacology and the Journal of New Drugs. 1967; 7(7):131–141.
- ↑ Food Standards Agency (2001) Statement on the Reproductive Effects of Caffeine. London: Food Standards Agency.
- ↑ Juliano LM and Griffiths RR. Caffeine. In Lowinson, J.H., Ruiz, P., Millman, R.B., Langrod, J.G. (Eds.). Substance Abuse: A Comprehensive Textbook, Fourth Edition. 2005. PP. 403-421. Baltimore: Lippincott, Williams, & Wilkins.
- ↑ Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010.
- ↑ Shannon MW. Theophylline and caffeine. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 65.
- ↑ Yew D, et al. Caffeine Toxicity Treatment & Management. Medscape. Updated: Mar 31, 2014.