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Study Title and Description

A case of fatal caffeine poisoning.



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 A case of fatal caffeine poisoning.
Author T Rudolph,K Knudsen,
Country
Year 2010
Numbers

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


Extraction Form: Acute Toxicity - Study Design Details
Arms
No arms have been defined in this extraction form.

Design Details
Question... Follow Up Answer Follow-up Answer
Refid 20096021
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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 report a case of a 21 year old female who ingested 10 grams (self report) of caffeine, after suffering ventricular fibrillation. Patient presented with profound hypokalemia, multiple ventricular fibrillation. Countershock and treatment (amiodarone) were administered, after 3 days in hospital patient developed myoclonus (muscle jerking) an did not respond to treatment. she suffered anoxic brain damage and died of pneumonia 11 d after caffeine poisoning
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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) general observation, Blood work, ECG, Hemodialysis, urinary output and neurological exam were all conducted
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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) general observation: awake after ingestion of 10, no medical history obtained
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List additional health endpoints (separately). extreme/ increased urine output
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List additional health endpoints (separately)
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Notes
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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 methods described above standard lab work, ECG,
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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
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Self-report Self-report
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Children
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Adolescents
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Adults 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 case report
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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) none- woman was unresponsive so no medical history taken, also no discussion of tox reports (i.e, no mention of if other drugs could have been in the system)
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Provide a general description of results (as reported by the authors). the 21 year old woman suffered cardiac arrest almost immediately after calling the ambulance and stating she ingested 10g of caffeine. Resuscitation including countercheck and 2mg epinephrine led to some stability but i. amiodarone was used as well as heart compressions. Hypokalemia and increased urinary output were noted. After becoming cardiac stable she was diagnosed with brain damage and died 11 days later of pneumonia
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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? excessive dose resulte in repeated ventricular fibrillation resistant to electrical defibrillation, probably due to a blockade of cardia adenosine receptors and intense beta-receptor activity. risk of arrhythmia may be increased by hypokalemia. Amiodarone is an antiarhythmic drug , combined with respiratory support and aggressive potassium substitution as well as hemodialysis stabilized the circulation. Authors note patient died of pneumonia following caffeine toxicity and point out that monitoring plasma potassium levels and caffeine levels would be valuable in risk post-resuscitation period.
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What were the sources of funding? none reported
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What conflicts of interest were reported? stated there were none
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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.  10g: cardiac arrest, hypkaelemia, high locate, ventricular fibrillation, extreme urnary output. Death due to pneumonia that followed caffeine intoxication
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. Brain damage and death were reported but death was due to pneumonia; however no discussion of other tox report (other drugs mentioned)
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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

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