Massive caffeine overdose with extremely high blood caffeine concentration and prolonged toxidrome

The easy availability of caffeine has led to an increased risk of ingesting toxic levels in recent years. Although several studies reported severe and fatal cases of massive caffeine poisoning, few cases of caffeine overdose with a protracted toxidrome have been described. We present the case of a 37-year-old man with a massive caffeine overdose. He presented with altered consciousness and non-sustained ventricular tachycardia and was intubated and placed on continuous venovenous hemodiafiltration. The patient was extubated but had to be reintubated on day 4 because of altered consciousness, tachypnea, and tachycardia. His renal and hepatic dysfunction worsened, requiring three sessions of hemodialysis. The patient was eventually extubated on day 8, without worsening of symptoms. The present case illustrates high caffeine concentration as a cause of prolonged toxidrome with hepatic and renal damage.