Severe caffeine intoxication after sustained nonsuicidal caffeine use requiring hemodialysis: a case report

Abstract Background Severe caffeine intoxication is well described after acute high-dose ingestion, whereas cases associated with sustained nonsuicidal caffeine use have been less frequently reported. We report a case of severe caffeine intoxication requiring hemodialysis in a patient who reported taking 400 mg/day of caffeine for 16 consecutive days. Case Presentation A previously healthy 26-year-old man developed nausea, vomiting, palpitations, marked sinus tachycardia, hypokalemia, hypophosphatemia, hyperglycemia, and lactic acidosis after 16 days of reported caffeine tablet use without suicidal intent. His serum caffeine concentration was 84.4 μg/mL. Emergency hemodialysis was followed by rapid clinical and metabolic improvement. Conclusions Severe caffeine intoxication should be considered even when the reported history does not suggest an acute overdose. A marked discrepancy between self-reported caffeine intake and serum caffeine concentration should prompt consideration of unrecognized additional exposure or atypical caffeine pharmacokinetics. Hemodialysis may be considered in selected patients with severe cardiovascular or metabolic manifestations.