Experience of acute caffeine poisoning treated with continuous hemodialysis

Abstract

We report a case of fatal caffeine poisoning treated with continuous hemodialysis(CHD). A man in his thirties called an ambulance because of sickness after ingested 13g of anhydrous caffeine. He presented tachycardia, hypertension and tonic clonic convulsion on arrival. His blood gas analysis showed, metabolic acidosis and elevated lactate level. His initial blood caffeine concentration was 132.68 µg/mL and we started CHD. His vital sings were stabilized 10 hours after CHD initiation, and we stopped CHD in 15 hours. He discharged at eighth hospital day after taken medical interview by psychiatrist. We calculated caffeine clearance during CHD and it was only 0.437 µg/min/kg. The value was lower than patient’s own liver clearance. In case of fatal caffeine poisoning, we need to consider bimodal elevation of blood caffeine concentration due to prolonged half value period and time of caffeine adsorption from intestine. We concerned about bimodal elevation after one session of HD, we decided to treat this patient with CHD. But the caffeine clearance during CHD was inefficient and not extended to HD. For this reason, the ideal strategy of blood purification therapy for caffeine poisoning was to decrease blood caffeine concentration immediately with HD and subsequently observe carefully.