title: Survival of a highly toxic dose of caffeine.
abstract: A 27-year-old woman with a history of depression and previous overdose presented within 60 min of ingestion of 50 g of caffeine powder. Initially alert but hypotensive and tachycardic, the patient developed a broad complex tachycardia followed by a seizure and multiple ventricular fibrillation (VF) arrests. Following multiple defibrillations for VF, eight cycles of cardiopulmonary resuscitation and treatment with amiodarone, lidocaine, magnesium and potassium supplementation, the patient went to the intensive care unit (ICU). While there, the patient had further VF and required haemofiltration for a profound metabolic acidaemia with cardiac rhythm instability. She developed a postcardiac arrest systemic inflammatory response syndrome with episodes of acute pulmonary oedema, profound vasoplegia, hypothermia and coagulopathy. After 5 days in the ICU, the patient was stable enough to be transferred to the ward, with a persistent sinus tachycardia, and was discharged 3 days later with cardiology and psychiatry follow-up.
authors: Department of Cardiology, St Helier Hospital, Surrey, UK. gabioh@doctors.org.uk
authors: Gabriel
authors: G
authors: Bioh
authors: Mark M
authors: MM
authors: Gallagher
authors: Usha
authors: U
authors: Prasad
mesh_terms: D000328:Adult; D002110:Caffeine / Q000506:poisoning*; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D013406:Suicide, Attempted; D013534:Survival; D014693:Ventricular Fibrillation / Q000139:chemically induced*
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine
references: Ann Emerg Med. 1989 Jan;18(1):94-7
references: 2642675
references: Ann Emerg Med. 1990 Jan;19(1):44-6
references: 1688693
references: Ann Emerg Med. 1985 Dec;14(12):1227-9
references: 4061999
references: Am J Emerg Med. 2009 Feb;27(2):253.e3-6
references: 19371553
references: Acta Anaesthesiol Scand. 2010 Apr;54(4):521-3
references: 20096021
references: Ann Emerg Med. 1997 Jan;29(1):178-80
references: 8998103
references: J Toxicol Clin Toxicol. 2003;41(7):1003-7
references: 14705850