Study Title and Description
Massive caffeine overdose requiring vasopressin infusion and hemodialysis.
Key Questions Addressed
|1||For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on acute toxicity*?|
Primary Publication Information
|Title||Massive caffeine overdose requiring vasopressin infusion and hemodialysis.|
|Author||CP Holstege,Y Hunter,AB Baer,J Savory,DE Bruns,JC Boyd,|
Secondary Publication Information
There are currently no secondary publications defined for this study.
Extraction Form: Acute Toxicity - Study Design Details
No arms have been defined in this extraction form.
|Question... Follow Up||Answer||Follow-up Answer|
|What outcome is being evaluated in this paper?||Acute|
|What is the objective of the study (as reported by the authors)?||to report on an unusual case of a 41 year old woman who ingested 50 grams of caffeine and survived after hemodyalsis and vasopressin treatment|
|Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods)||case presented to emergency room, caffeine measured in serum (405 mg/L), other vital signs noted in quite good detail|
|How many outcome-specific endpoints are evaluated?||4|
|What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately)||serum caffeine evaluated as 405 mg/L|
|List additional health endpoints (separately).|
|List additional health endpoints (separately)|
|Notes||I listed these as these end points (CV-changes/seizure/serum caffeine) are all common to caffeine acute toxicity in overdose|
|What is the study design?||Case report|
|Randomized or Non-Randomized?|
|What were the diagnostics or methods used to measure the outcome?||Both|
|Optional: Name of Method or short description||emergency room procedures (blood drawn/analyzed by hospital lab, ECG measured tachycardia, tonic clonic seizure would have been objective noted by doctor|
|What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.)||none this is a case report|
|What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models. Copy from methods)||they mentioned alcohol intake but ruled it out based on blood chemistry no ethanol or other drugs|
|Provide a general description of results (as reported by the authors).||41 year suicidal female ingest 50 g caffeine 3 hours prior to admittance, serum caffeine was 405 mg/L ethanol, salicylate and acetaminophen not detected. Blood pressure dropped to 90 systolic then 80s, tachycardia degenerated into 3rd degree AV block, after receiving CaCl2 and MgSO4 she developed a tonic-clonic seizure. Vasopressin was begun hemodialysis performed 10 hr after arrival , blood pressure improved. Intubated for 17 days , 24 days after arrival returned home made full recovery|
|Did the authors perform a dose-response analysis (or trend/related analysis)?||No|
|What were the authors's observations re: trend analysis?|
|What were the author's conclusions?||This massive caffeine overdose is remarkable for a number of reasons. This is the first reported use of either vasopressin or hemodialysis in caffeine overdose. This is the highest serum caffeine level reported to have survived. This case also stresses the importance of continued resuscitation despite dire clinical situations in drug overdose patients.|
|What were the sources of funding?||none listed|
|What conflicts of interest were reported?||none listed - this is a case report of near fatality|
|Does the exposure (dose) need to be standardized to the SR?||No|
|Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest).|
|List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot. Characterize value as LOAEL/NOAEL, etc. if possible.||50g caffeine associated with adverse effects (tachycardia, AV block, seizure, low systolic bp) but patient survived after treated with vasopressin and hemodialysis|
|Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot.||50 g oral exposure equated to 405mg/L; acute toxicity nearly lethal but medically treatable.|
|What is the importance of the study with respect to the adverseness of the outcome?||Critcal|
No baseline characteristics have been defined for this extraction form.
Results & Comparisons
No Results found.
|Arm or Total||Title||Description||Comments|
No quality dimensions were specified.
No quality rating data was found.