Mitsui Daichi, Kamijo Yoshito, Yoshino Takumi, Hanazawa Tomoki, Yoshizawa Tomohiro, Iwase Fumiaki
Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, 1-1-1, Fujimi, Kofu City, Yamanashi 400-0027, Japan.
Clinical Toxicology Center, Saitama Medical University Hospital, 38, Hongo, Moroyama-machi, Iruma-gun, Sitama 350-0495, Japan.
Am J Emerg Med. 2024 Feb;76:270.e5-270.e7. doi: 10.1016/j.ajem.2023.12.014. Epub 2023 Dec 12.
Caffeine poisoning can cause fatal ventricular arrhythmias. In this report, we describe a case of severe caffeine poisoning with extraordinarily high blood caffeine levels. Despite developing refractory ventricular fibrillation, the patient was successfully treated with intermittent hemodialysis (IHD) under circulatory support by venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 22-year-old male was transported to our hospital approximately 2.5 h after ingesting 200 highly caffeinated tablets (200 mg/tablet) (40 g caffeine total) in a suicide attempt. On arrival, the patient vomited frequently with a Glasgow Coma Scale score E3V2M5, heart rate 185 beats/min, and a blood pressure of 97/62 mmHg. Shortly after arrival, the patient developed ventricular fibrillation which was refractory either to three electrical defibrillations or antiarrhythmic drugs, resulting in endotracheal intubation for mechanical ventilation and VA-ECMO. Starting from 2 h after arrival, intermittent hemodialysis (IHD) was performed for 11 h, which markedly improved clinical symptoms and circulatory parameters. Serum caffeine level was 454.9 mg/dL upon arrival at the hospital, but it decreased to 55.5 mg/dL by the end of IHD treatment. Renal replacement therapy (RRT) including intermittent hemodiafiltration, continuous hemodiafiltration, and IHD was continued because of rhabdomyolysis with myoglobinuria and secondary caused acute kidney injury. The patient was weaned off VA-ECMO on hospital day 7, extubated on hospital day 18, weaned from RRT on hospital day 46, and was transferred to another hospital for physical rehabilitation on hospital day 113. IHD under circulatory support by VA-ECMO should be considered in severe caffeine poisoning causing potentially fatal arrhythmias.
咖啡因中毒可导致致命的室性心律失常。在本报告中，我们描述了一例严重咖啡因中毒且血咖啡因水平异常高的病例。尽管患者出现了难治性心室颤动，但在静脉 - 动脉体外膜肺氧合（VA - ECMO）循环支持下，通过间歇性血液透析（IHD）成功治愈。一名22岁男性在自杀企图中摄入200片高咖啡因片（每片200毫克）（共40克咖啡因）后约2.5小时被送往我院。到达时，患者频繁呕吐，格拉斯哥昏迷量表评分为E3V2M5，心率185次/分钟，血压97/62 mmHg。到达后不久，患者出现心室颤动，对三次电击除颤或抗心律失常药物均无效，导致气管插管进行机械通气并使用VA - ECMO。到达后2小时开始，进行了11小时的间歇性血液透析（IHD），这显著改善了临床症状和循环参数。入院时血清咖啡因水平为454.9毫克/分升，但在IHD治疗结束时降至55.5毫克/分升。由于横纹肌溶解伴肌红蛋白尿及继发的急性肾损伤，继续进行包括间歇性血液透析滤过、连续性血液透析滤过和IHD在内的肾脏替代治疗（RRT）。患者于住院第7天撤掉VA - ECMO，第18天拔管，第46天停止RRT，并于第113天转至另一家医院进行身体康复治疗。对于导致潜在致命心律失常的严重咖啡因中毒，应考虑在VA - ECMO循环支持下进行IHD。
