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Study Title and Description

Treatment of cardiovascular collapse from caffeine overdose with lidocaine, phenylephrine, 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*?
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Primary Publication Information
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TitleData
Title Treatment of cardiovascular collapse from caffeine overdose with lidocaine, phenylephrine, and hemodialysis.
Author R Kapur,MD Smith,
Country
Year 2009
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Acute Toxicity - Study Design Details
Arms
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 19371553
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What outcome is being evaluated in this paper? Acute
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What is the objective of the study (as reported by the authors)? to share a case report documenting the use of phenylephrine as a treatment for hemodynamic instability and hypotension after massive caffeine overdose (10-20g caffeine)
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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) 18 year old man suicide attempt with caffeine- they took medical history, dextrose stick, electrocardiogram, laboratory blood work, urinalysis and dialysis
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How many outcome-specific endpoints are evaluated? 5
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) medical history/observations: anxious and diaphoretic, nausea and vomiting; heart rate 80 ppm; bp 110/60 mm Hg; altered mental state
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List additional health endpoints (separately). dialysis (kidney failure)
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List additional health endpoints (separately)
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Notes phenylephrine (alpha-receptor agonist) was chosen for treatment to increase peripheral vascular resistance and cause reflex bradycardia
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Clinical Clinical
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Physiological Physiological
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Other
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What is the study design? Case report
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Both
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Optional: Name of Method or short description described above under outcomes
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Caffeine (general)
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Coffee
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Chocolate
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Energy drinks
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Gum
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Medicine/Supplement Medicine/Supplement
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Soda
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Tea
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Measured Measured
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Self-report Self-report
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Children
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Adolescents Adolescents
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Adults
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Pregnant Women
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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 -ED visit
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) blood work and urinalysis done for other drugs but results not reported for drug screen; no family history discussed; ethanol, salicylate, acetaminophen and lithium were also in the system as noted by lab work.
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Provide a general description of results (as reported by the authors). 18 year old ingested 10g caffeine (although authors noted the bottle was empty which could have meant 20g caffeine) in a suicide attempt. Patient exhibited vomiting, nausea, marked cardiac instability, anxiety, and was intubated. mild leukocytosis and hypokalemia were noted and dialysis was implemented. Treatment with phenylephrine an alpha-receptor agonist was successful and as a therapy is recommended for hemodynamic instability in caffeine overdose
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? Cardiac instability was the major effect where by efforts were made to remedy. Given baseline EKG with QTc prolongation use of amiodarone was cautioned against and phenylephrine was determined successful as was dialysis. Lidocaine was also noted as successfully used so authors conclude that both of these medications should be considered in cardiovascular collapse associated with methylxanthine poisoning.
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What were the sources of funding? none reported
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What conflicts of interest were reported? none reported
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Does the exposure (dose) need to be standardized to the SR? No
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest).
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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.  cardiac instability, nausea, vomiting, shallow breathing, kidney failure: 10g
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. also the self report of 10g could have been low as all the caffeine pills were missing and the total would have been 20g
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What is the importance of the study with respect to the adverseness of the outcome? Important
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Baseline Characteristics
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Results & Comparisons

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Adverse Events
Arm or Total Title Description Comments

Quality Dimensions
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