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Study Title and Description

Survival of a highly toxic dose of caffeine.



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 Survival of a highly toxic dose of caffeine.
Author G Bioh,MM Gallagher,U Prasad,
Country
Year 2013
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 23396922
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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)? Survival of a massive overdose of caffeine is rare with only one other reported survival of 50 g caffeine ingestion; hence, detailing the natural history and successful management of such a case is a useful addition to the medical literature. This case illustrates the life-threatening consequences of severe caffeine poisoning. It highlights the typical symptoms at presentation and the effective management of a life-threatening dose of 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) NA - case report
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How many outcome-specific endpoints are evaluated? 3
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Seizure
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List additional health endpoints (separately).
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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? Objective
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Optional: Name of Method or short description
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Caffeine (general) 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
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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.) NA - 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) NA - case report
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Provide a general description of results (as reported by the authors). Her initial observations were as follows: the patient appeared unwell and sweaty, Glasgow Coma Scale 15/15, respiratory rate 20 with normal depth, oxygen saturations 100% on air, pulse 179 bpm, blood pressure (BP) 100/51, blood sugar 7.4, temperature 35.6°C. The patient arrived in the accident and emergency department (A&E) within an hour of ingestion of the caffeine powder. Soon after arrival, the patient had a brief seizure followed by a ventricular fibrillation (VF) arrest requiring cardiopulmonary resuscitation (CPR) and defibrillation to return to spontaneous circulation. The initial ECG showed a broad complex tachycardia, a ventricular alternans rhythm (figure 1). The initial cardiac arrest arterial blood gas (ABG) showed: pH 7.05, pCO2 5.68, pO2 6.73, K+ 2.8, lactate 11.3, base excess 16.6 and bicarbonate 10.9. Initial venous blood results: Na+ 149 mmol/l, K+ 4.4 mmol/l, Mg2+ 1.24 mmol/l, bicarbonate 8 mmol/l, urea 4.0 mmol/l, creatine 86μmol/l, C reactive protein <4 mg/l, glucose 11.9 mmol/l, bilirubin 6 μmol/l, alanine transaminase 75 u/l, alkaline phosphatase 76 u/l, albumin 47 g/l, haemoglobin 14.5 g/dl, mean cell volume 93.6 fl, white cell count 21.3×109/l, and platelets 409×109/l. An initial toxicology screen for salicylates and paracetamol was ordered: salicylate, not detected; paracetamol, not detected. Unfortunately, no serum caffeine concentration sample was obtained.
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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? Initially alert but hypotensive and tachycardic, the patient developed a broad complex tachycardia followed by a seizure and multiple ventricular fibrillation (VF) arrests. Following multiple defibrillations for VF, eight cycles of cardiopulmonary resuscitation and treatment with amiodarone, lidocaine, magnesium and potassium supplementation, the patient went to the intensive care unit (ICU). While there, the patient had further VF and required haemofiltration for a profound metabolic acidaemia with cardiac rhythm instability. She developed a postcardiac arrest systemic inflammatory response syndrome with episodes of acute pulmonary oedema, profound vasoplegia, hypothermia and coagulopathy. After 5 days in the ICU, the patient was stable enough to be transferred to the ward, with a persistent sinus tachycardia, and was discharged 3 days later with cardiology and psychiatry follow-up.
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What were the sources of funding? NA
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What conflicts of interest were reported? No competing interests
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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.  Ventricular fibrillation arrest LOAEL = 50 g Hypothermia LOAEL = 50 g Seizure LOAEL = 50 g
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot.
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What is the importance of the study with respect to the adverseness of the outcome? Critcal
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Baseline Characteristics
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Results & Comparisons

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Adverse Events
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