title: Massive caffeine overdose requiring vasopressin infusion and hemodialysis.
abstract: BACKGROUND
  Massive caffeine overdose is associated with life-threatening hemodynamic complications that present challenges for clinicians. We describe the highest-reported serum concentration of caffeine in a patient who survived and discuss the first-reported use of vasopressin and hemodialysis in a caffeine-poisoned patient.
  
  
  METHODS
  A 41-yr-old woman presented 3 h after ingesting approximately 50 g of caffeine. She subsequently underwent cardiopulmonary resuscitation and received multiple medications in an attempt to raise her blood pressure and control her heart rate without success. Vasopressin infusion increased her blood pressure to the point where hemodialysis could be performed. Despite ensuing multisystem organ failure, she survived and has made a complete recovery.
  
  
  CONCLUSIONS
  Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine-intoxicated patients who fail to respond to standard therapies.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia 22908-0699, USA. ch2xf@virginia.edu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Holstege
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hunter
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Baer
authors.forename: John
authors.initials: J
authors.lastname: Savory
authors.forename: David E
authors.initials: DE
authors.lastname: Bruns
authors.forename: James C
authors.initials: JC
authors.lastname: Boyd
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002110:Caffeine / Q000506:poisoning*; D062787:Drug Overdose / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D006435:Renal Dialysis; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014667:Vasopressins; D002110:Caffeine