No activated charcoal was administered as the medical team was unaware of a dietary product ingestion during the initial evaluation. The supportive treatment, including intravenous fluids, propranolol, potassium and phosphorus supplementations, stabilised the patient’s clinical status. Unfortunately, a blood sample for caffeine analysis was not taken.Įchocardiogram revealed a structurally normal heart. Urinalysis was positive for ketones and glucose and negative for cocaine and opioid drugs. Magnesium and calcium serum values were within normal range as well as thyroid, renal and liver function tests. The initial group of complementary exams was:Įlectrocardiogram ( figures 2 and 3) showing a broad QRS polymorphic tachycardia.Īrterial blood gas showed a metabolic acidosis with pH of 7.296 (7.35–7.45), pCO 2 of 29.9 mm Hg, pO 2 of 117 mm Hg, HCO 3 of 16.1 mmol/L (22–26) and severe lactataemia with serum lactate level of 5.3 mmol/L (0.5–1.6). The patient switched the dose dispensers shown in figure 1. Acid–base and hydroelectrolytic disorders were also corrected.Īfter stabilisation, the patient informed the ED’s physician that when she was preparing the preworkout supplement, used the same dosage of the proteic supplement for anhydrous caffeine, instead of 1 dose of 300 mg (6 mg/kg) of anhydrous caffeine, the patient consumed a total of 5000 mg (89 mg/kg), 30 min before going to the ED. The dysrhythmia was successfully treated with 5 mg of propranolol intravenous in total. The ECG showed a polymorphic broad QRS tachycardia and the arterial blood gas revealed metabolic acidaemia with severe hypokalemia. Her pupils were equally round and reactive to light, and no muscle weakness or sensory deficits were found. Also, the blood sugar was 147 mg/dL.Īfter observation, the patient had an episode of presyncope followed by agitation and vomiting. At this point, the patient was pale and sweaty with a GCS of 11 (eye opening: 4 verbal response: 2 motor response: 5), blood pressure of 115/75 mm Hg, tachycardia (160 beats/min) and 99% oxygen saturation on room air.

The initial physical examination at triage revealed a Glasgow Coma Scale (GCS) of 15, a respiratory rate of 19 breaths/min, 100% oxygen saturation on room air, blood pressure of 112/70 mm Hg, pulse of 80 beats/min and had a normal tympanic temperature. Symptoms like chest pain, syncope, palpitations or fever were denied. A 32-year-old woman with no significant medical and family history presented to the local emergency department (ED) referring malaise, anxiety, dizziness and nausea.

Caffeine overdose