A review of published case reports suggests that severe caffeine intoxication can lead to life-threatening complications, and extracorporeal blood purification was linked to higher survival in patients with the most severe presentations.
The analysis evaluated 216 reported cases of caffeine intoxication between 1883 and 2023, identified through PubMed, Google Scholar, and Semantic Scholar. Among 134 patients initially found alive, the median reported ingestion was 12 g, with a median serum caffeine concentration of 160 mg/L. Intoxication was associated with suicidal intent in 40% of cases, accidental exposure in 22%, and treatment error in 6%. The researchers assessed clinical manifestations, treatment approaches, and survival outcomes, including associations between symptom severity, caffeine dose or serum concentration, and prognosis.
Severe toxicity primarily involved cardiovascular and neurologic complications. Tachycardia occurred in 87% of patients, and convulsions were reported in 18%. Ventricular arrhythmias were also common, including ventricular tachycardia (13%) and ventricular fibrillation (14%). Doses of 5–10 g were considered potentially lethal.
Worse outcomes were associated with greater symptom severity. Patients with convulsions or wide-complex tachycardia had worse prognosis compared with those without these features. However, similar caffeine doses and serum concentrations produced varying clinical presentations.
Management strategies varied widely. Activated charcoal was administered in 22% of cases, and gastric decontamination in 11%. Extracorporeal blood purification, including hemodialysis, was used in 28% of cases and more often in patients with severe arrhythmias. Survival was higher among patients receiving blood purification (95% vs 73%), despite higher median ingestion (29 g vs 6 g) and higher serum caffeine concentrations (185 mg/L vs 121 mg/L) in the treated group.
Outcomes varied even among patients with similar reported exposures, and survival was reported in some cases with ingestions as high as 100 g following aggressive treatment.
The authors noted several limitations, including the retrospective design, reliance on case reports, incomplete data, and potential publication bias. Treatment comparisons are constrained because patients receiving extracorporeal therapies were generally more severely ill, and no controlled comparisons were available.
The researchers noted that “no definitive treatment recommendations can be derived” and that caffeine elimination by hemodialysis “can be considered if the quantity ingested is potentially lethal, or in cases with a severe clinical course,” wrote lead study author Sabrina Uehlein, of Hannover Medical School, and colleagues.
Disclosures: The researchers reported no conflicts of interest and no external funding.
