title: Severe acute caffeine poisoning due to intradermal injections: mesotherapy hazard.
abstract: BACKGROUND
  Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning.
  
  
  METHODS
  A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT) on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L), and a toxicological analysis (liquid chromatography with ultraviolet detection) proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L). On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days.
  
  
  CONCLUSIONS
  A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the subcutaneous adipose tissue into the circulation when injected directly into the tiny blood vessels, as evidenced by hematoma formation. Poisoning manifestations were registered in gastrointestinal, CNS (anxiety, somnolence) and cardiovascular (hypotension, ventricular tachycardia and nonsustained PSVT) system. In this era of mesotherapeutic treatment promotion, one should keep in mind toxic prevention, with application being carried out exclusively in a specialized institution.
authors.affiliation: Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade Serbia.
authors.forename: Natasa Perković
authors.initials: NP
authors.lastname: Vukcević
authors.forename: Gordana
authors.initials: G
authors.lastname: Babić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Segrt
authors.forename: Gordana Vuković
authors.initials: GV
authors.lastname: Ercegović
authors.forename: Snezana
authors.initials: S
authors.lastname: Janković
authors.forename: Ljubomir
authors.initials: L
authors.lastname: Aćimović
mesh_terms: D002110:Caffeine / Q000008:administration & dosage / Q000506:poisoning*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D057748:Mesotherapy / Q000009:adverse effects*; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D002110:Caffeine