Electrocardiogram Abnormalities of Caffeine Overdose
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Caffeine is a widely popular, naturally occurring plant alkaloid that is classified as a methylated xanthine derivative. It is found in a variety of products, most notably coffee, carbonated beverages, and so-called energy drinks. Previous studies have confirmed that typical caffeine consumption is not generally associated with an increased risk of arrhythmias.1 Even at moderate doses (defined as <6 cups of coffee daily), caffeine is well tolerated, and there is little evidence to support that at this dosage it is proarrhythmic.1 However, intake of unusually large amounts of caffeine, where quantities are generally >10 g, has been associated with tachydysrhythmias, including organized supraventricular tachycardia, ventricular tachycardia, and ventricular fibrillation (VF). Because of the increasing popularity of caffeinated energy drinks, there is an increased risk for caffeine toxicity, and as a result, the clinical entity of acute caffeine toxicity may become a more common pathology. Therefore, it is important to not only recognize the effects of caffeine on the cardiovascular system at toxic doses but also to be aware of management strategies.
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A 29-year-old female patient with a history of severe depression and prior suicide attempts presented to the Emergency Department after ingestion of ≈36 to 40 g of caffeine. Before arrival, she admitted to taking 180 to 200 pills of NoDoz brand caffeine, each pill containing ≈200 mg of caffeine. She denied taking any additional prescription medications or substances other than the caffeine pills.
On presentation to the emergency room, the patient …