Skip to main content
Erschienen in: Journal of Anesthesia 5/2016

07.06.2016 | Clinical Report

Intralipid in acute caffeine intoxication: a case report

verfasst von: Luisa Muraro, Laura Longo, Federico Geraldini, Andrea Bortot, Andrea Paoli, Annalisa Boscolo

Erschienen in: Journal of Anesthesia | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

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.
Literatur
1.
Zurück zum Zitat Baselt RC. Disposition of toxic drugs and chemicals in man. 7th ed. Foster City: Biomedical Publications; 2004. p. 157–9. Baselt RC. Disposition of toxic drugs and chemicals in man. 7th ed. Foster City: Biomedical Publications; 2004. p. 157–9.
2.
Zurück zum Zitat Gilman AG, Rall TW, Nies AS, Taylor P. Goodman and Gilman’s: the pharamcological basis of therapeutics. 8th ed. New York: Pergamon Press; 1990. p. 120–3. Gilman AG, Rall TW, Nies AS, Taylor P. Goodman and Gilman’s: the pharamcological basis of therapeutics. 8th ed. New York: Pergamon Press; 1990. p. 120–3.
3.
Zurück zum Zitat Hughes JR, Oliveto AH, Helzer JE, Higgins ST, Bickel WK. Should caffeine abuse, dependence, or withdrawal be added to DSM-IV and ICD-10? Am J Psychiatry. 1992;149(1):33–40.CrossRefPubMed Hughes JR, Oliveto AH, Helzer JE, Higgins ST, Bickel WK. Should caffeine abuse, dependence, or withdrawal be added to DSM-IV and ICD-10? Am J Psychiatry. 1992;149(1):33–40.CrossRefPubMed
4.
Zurück zum Zitat Oberstar JV, Bernstein GA, Thuras PD. Caffeine use and dependence in adolescents: 1 year follow-up. J Child Adolesc Psychopharmacol. 2002;12(2):127–35.CrossRefPubMed Oberstar JV, Bernstein GA, Thuras PD. Caffeine use and dependence in adolescents: 1 year follow-up. J Child Adolesc Psychopharmacol. 2002;12(2):127–35.CrossRefPubMed
5.
Zurück zum Zitat O’Connell SE, Zurzola FJ. Rapid quantitative liquid chro- matographic determination of caffeine levels in plasma after oral dosing. J Pharm Sci. 1984;73(7):1009–11.CrossRefPubMed O’Connell SE, Zurzola FJ. Rapid quantitative liquid chro- matographic determination of caffeine levels in plasma after oral dosing. J Pharm Sci. 1984;73(7):1009–11.CrossRefPubMed
6.
Zurück zum Zitat Kaplan GB, Greenblatt DJ, Ehrenberg BL, Goddarb JE, Cotreau MH, Harmatz JS, Shader RI. Dose- dependent pharmacokinetics and psychomotor effects of caffeine in humans. J Clin Pharamcol. 1997;37(8):693–703.CrossRef Kaplan GB, Greenblatt DJ, Ehrenberg BL, Goddarb JE, Cotreau MH, Harmatz JS, Shader RI. Dose- dependent pharmacokinetics and psychomotor effects of caffeine in humans. J Clin Pharamcol. 1997;37(8):693–703.CrossRef
7.
Zurück zum Zitat Echeverri D, Montes RF, Caberera M, Galán A, Pietro A. Caffeine’s vascular mechanisms of action. Int J Vasc Med. 2010;2010:834060.PubMedPubMedCentral Echeverri D, Montes RF, Caberera M, Galán A, Pietro A. Caffeine’s vascular mechanisms of action. Int J Vasc Med. 2010;2010:834060.PubMedPubMedCentral
8.
Zurück zum Zitat Kerrigan S, Lindsey T. Fatal caffeine overdose: two case reports. Forensic Sci Int. 2005;153(1):67–9.CrossRefPubMed Kerrigan S, Lindsey T. Fatal caffeine overdose: two case reports. Forensic Sci Int. 2005;153(1):67–9.CrossRefPubMed
9.
Zurück zum Zitat Winek CL, Wahba WW, Winek CL Jr, Balzer TW. Drug and chemical blood-level data 2001. Forensic Sci Int. 2001;122(2–3):107–23.CrossRefPubMed Winek CL, Wahba WW, Winek CL Jr, Balzer TW. Drug and chemical blood-level data 2001. Forensic Sci Int. 2001;122(2–3):107–23.CrossRefPubMed
11.
12.
Zurück zum Zitat Brent J. Poisoned patients are different-sometimes fat is a good thing. Crit Care Med. 2009;37(3):1157–8.CrossRefPubMed Brent J. Poisoned patients are different-sometimes fat is a good thing. Crit Care Med. 2009;37(3):1157–8.CrossRefPubMed
13.
Zurück zum Zitat Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. JPEN J Parenter Enteral Nutr. 2015;39(1Suppl):72S–83S.CrossRefPubMed Fettiplace MR, Weinberg G. Past, present, and future of lipid resuscitation therapy. JPEN J Parenter Enteral Nutr. 2015;39(1Suppl):72S–83S.CrossRefPubMed
14.
Zurück zum Zitat Fettiplace MR, Lis Kinga, Ripper R, Kowal K, Pichurko A, Vitello D, Rubinstein I, Schwartz D, Akpa BS, Weinberg G. Multi-modal contributions to detoxication of acute pharmacotoxicity by a triglyceride micro-emulsion. J Control Release. 2015;198:62–70.CrossRefPubMed Fettiplace MR, Lis Kinga, Ripper R, Kowal K, Pichurko A, Vitello D, Rubinstein I, Schwartz D, Akpa BS, Weinberg G. Multi-modal contributions to detoxication of acute pharmacotoxicity by a triglyceride micro-emulsion. J Control Release. 2015;198:62–70.CrossRefPubMed
15.
Zurück zum Zitat Fettiplace MR, Kowal K, Ripper R, Young A, Lis K, Rubinstein I, Bonini M, Minshall R, Weinberg G. Insulin signaling in bupivacaine-induced cardiac toxicity sensitization during recovery and potentiation by lipid emulsion. Anesthesiology. 2016;124:428–42.CrossRefPubMed Fettiplace MR, Kowal K, Ripper R, Young A, Lis K, Rubinstein I, Bonini M, Minshall R, Weinberg G. Insulin signaling in bupivacaine-induced cardiac toxicity sensitization during recovery and potentiation by lipid emulsion. Anesthesiology. 2016;124:428–42.CrossRefPubMed
16.
Zurück zum Zitat Picard J, Meek T. Lipid emulsion for intoxication by local anesthetic: sunken sink? Anesthesia. 2016;. doi:10.1111/anae.13395 (Epub ahead of print). Picard J, Meek T. Lipid emulsion for intoxication by local anesthetic: sunken sink? Anesthesia. 2016;. doi:10.​1111/​anae.​13395 (Epub ahead of print).
17.
Zurück zum Zitat Schmidt M, Farna H, Kurcova I, Zakharov S, Fric M, Waldauf P, Ligova Z, Pazout J, Duska F. Succesfull treatment of supralethal caffeine overdose with a combination of lipid infusion and dialysis. Am J Emerg Med. 2015;33:738 e5–e7.CrossRefPubMed Schmidt M, Farna H, Kurcova I, Zakharov S, Fric M, Waldauf P, Ligova Z, Pazout J, Duska F. Succesfull treatment of supralethal caffeine overdose with a combination of lipid infusion and dialysis. Am J Emerg Med. 2015;33:738 e5–e7.CrossRefPubMed
18.
Zurück zum Zitat Kapur R, Smith Micheal D. Treatment of cardiovascular collapse from caffeine overdose with lidocaine, phenylephrine and hemodialysis. Am J Emerg Med. 2009;27:253e3–6.CrossRef Kapur R, Smith Micheal D. Treatment of cardiovascular collapse from caffeine overdose with lidocaine, phenylephrine and hemodialysis. Am J Emerg Med. 2009;27:253e3–6.CrossRef
19.
Zurück zum Zitat Ishigaki S, Fukasawa H, Kinoshita-Katahashi N, Yasuda H, Kumagai H, Furuya R. Caffeine intoxication successfully treated by hemoperfusion and hemodialysis. Intern Med. 2014;53:2745–7.CrossRefPubMed Ishigaki S, Fukasawa H, Kinoshita-Katahashi N, Yasuda H, Kumagai H, Furuya R. Caffeine intoxication successfully treated by hemoperfusion and hemodialysis. Intern Med. 2014;53:2745–7.CrossRefPubMed
20.
Zurück zum Zitat Price KR, Fligner DJ. Treatment of caffeine toxicity with esmolol. Ann Emerg Med. 1990;19(1):44–6.CrossRefPubMed Price KR, Fligner DJ. Treatment of caffeine toxicity with esmolol. Ann Emerg Med. 1990;19(1):44–6.CrossRefPubMed
21.
Zurück zum Zitat Seneff M, Scoot J, Freidman B, Smith M. Acute theophylline toxicity and the use of esmolol to reverse cardiovascular instability. Ann Emerg Med. 1990;19(6):671–3.CrossRefPubMed Seneff M, Scoot J, Freidman B, Smith M. Acute theophylline toxicity and the use of esmolol to reverse cardiovascular instability. Ann Emerg Med. 1990;19(6):671–3.CrossRefPubMed
Metadaten
Titel
Intralipid in acute caffeine intoxication: a case report
verfasst von
Luisa Muraro
Laura Longo
Federico Geraldini
Andrea Bortot
Andrea Paoli
Annalisa Boscolo
Publikationsdatum
07.06.2016
Verlag
Springer Japan
Erschienen in
Journal of Anesthesia / Ausgabe 5/2016
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-016-2198-x

Weitere Artikel der Ausgabe 5/2016

Journal of Anesthesia 5/2016 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.