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Study Title and Description

Fatal cardiac arrhythmia following voluntary caffeine overdose in an amateur body-builder athlete.



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 Fatal cardiac arrhythmia following voluntary caffeine overdose in an amateur body-builder athlete.
Author M Poussel,A Kimmoun,B Levy,N Gambier,F Dudek,E Puskarczyk,JF Poussel,B Chenuel,
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
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 23465232
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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)? We report a fatal cardiac arrhythmia following voluntary caffeine overdose in an amateur body-builder athlete.
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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? 2
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Cardiac arrest
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes Cardiac arrest due to ventricular fibrillation
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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). A depressive 44-year-old male presented itself to the local emergency department after having intentionally ingested a huge amount (10 g) of pure anhydrous caffeine (1,3,7-trimethylxanthine). Initial physical examination noted a sweaty, trembling and tachypneic patient. Vital signs revealed a blood pressure of 123/83 mm Hg, heart rate of 75 beats per minute and oxygen saturation 100% on ambient air. Five minutes later, a cardiac arrest due to ventricular fibrillation (VF) occurred. Initial laboratory investigation showed abnormal findings including elevated white blood cell count of 14.740 G/L, lowered potassium level (2.6 mmol/L; reference range [RR], 3.5–5.0 mmol/L) and elevated glycemia (4.02 g/L; RR, 0.70–1.10 g/L). Rhabdomyolysis was suggested by elevated creatine kinase (CK, 9040 UI/L; RR, b171 UI/L) and cardiac damages by elevated cardiac enzymes: Troponin I (31.01 μg/L; RR, b0.04 μg/L) and CK-MB (346 UI/L; RR, b24 UI/L). A toxicology screening was performed and revealed markedly elevated levels of caffeine in the blood sample (190.0 mg/L; therapeutic range, 5–20 mg/L; toxic,>50 mg/L). No drug of abuse was found in urine. Under ECMO device, a high volume (35 mL/kg/h) continuous venovenous hemofiltration (CVVHF) was immediately started to clear caffeine in the blood. Caffeine persisted as toxic blood levels (145.2 mg/L initially and 130.1 mg/L after 2 h of CVVHF). The patient died in refractory shock state 13 h after the voluntary ingestion of pure anhydrous caffeine and 4 h after being under arterio-veinous ECMO.
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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? The patient described ingested massive amount of caffeine followed by VF and death with toxicological evidence of caffeine intoxication supporting a strong causality between both events. Intensivists and emergency physicians should be aware of the increasing incidence of misused caffeine in amateur sports activities in case of unusual intractable ventricular arrhythmias with an unclear context. The knowledge of its specific pathophysiology may improve management and may avoid fatal issue.
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What were the sources of funding? NA
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What conflicts of interest were reported? NA
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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 arrest LOAEL = 10 g Death LOAEL = 10 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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