Intralipid in acute caffeine intoxication: a case report.
Caffeine is arguably the most widely used stimulant drug in the world. Here we describe a suicide attempt involving caffeine overdose whereby the patient's severe intoxication was successfully treated with the prompt infusion of Intralipid. A 19-year-old man was found in an agitated state at home by the volunteer emergency team about 1 h after the intentional ingestion of 40 g of caffeine (tablets). His consciousness decreased rapidly, followed quickly by seizures, and electrocardiographic monitoring showed ventricular fibrillation. Advanced life support maneuvers were started immediately, with the patient defibrillated 10 times and administered 5 mg epinephrine in total and 300 + 150 mg of amiodarone (as well as lidocaine and magnesium sulfate). The cardiac rhythm eventually evolved to asystole, necessitating the intravenous injection of epinephrine to achieve the return of spontaneous circulation. However, critical hemodynamic instability persisted, with the patient's cardiac rhythm alternating between refractory irregular narrow complex tachycardia and wide complex tachycardia associated with hypotension. In an attempt to restore stability we administered three successive doses of Intralipid (120 + 250 + 100 mg), which successfully prevented a severe cardiovascular collapse due to a supra-lethal plasma caffeine level (>120 mg/L after lipid emulsion). The patient survived without any neurologic complications and was transferred to a psychiatric ward a few days later. The case emphasizes the efficacy of intravenous lipid emulsion in the resuscitation of patients from non-local anesthetic systemic toxicity. Intralipid appears to act initially as a vehicle that carries the stimulant drug away from heart and brain to less well-perfused organs (scavenging mechanism) and then, with a sufficient drop in the caffeine concentration, possibly as a tonic to the depressed heart.
Anesthesia and Intensive Care Unit (UOC), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy. mdluigia@gmail.com.
Luisa
L
Muraro
Anesthesia and Intensive Care Unit (UOC), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy.
Laura
L
Longo
Anesthesia and Intensive Care Unit (UOC), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy.
Federico
F
Geraldini
Pre-hospital Emergency Service (SUEM 118), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy.
Andrea
A
Bortot
Pre-hospital Emergency Service (SUEM 118), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy.
Andrea
A
Paoli
Anesthesia and Intensive Care Unit (UOC), Hospital of Padova, 2, Giustiniani St., 35128, Padua, Italy.
Annalisa
A
Boscolo
D022561:Advanced Cardiac Life Support; D000638:Amiodarone / Q000627:therapeutic use; D000931:Antidotes / Q000633:toxicity*; D002110:Caffeine / Q000506:poisoning*; D062787:Drug Overdose; D004655:Emulsions / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010743:Phospholipids / Q000627:therapeutic use*; D012769:Shock / Q000517:prevention & control; D013024:Soybean Oil / Q000627:therapeutic use*; D013610:Tachycardia / Q000139:chemically induced / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000139:chemically induced / Q000000981:diagnostic imaging; D055815:Young Adult
D000931:Antidotes; D004655:Emulsions; D010743:Phospholipids; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; C545823:soybean oil, phospholipid emulsion; D002110:Caffeine; D013024:Soybean Oil; D000638:Amiodarone; D004837:Epinephrine
Caffeine; Intoxication; Intralipid; Intravenous lipid emulsion