UMEM Educational Pearls - By Melissa Rice

Category: Pediatrics

Title: Pediatric Caffeine Overdose

Keywords: Caffeine, Energy Drinks, Overdose, Tox, Pediatrics (PubMed Search)

Posted: 2/13/2015 by Melissa Rice, MD
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Pediatric Caffeine Overdose

As the in-service draws closer and the hours to study wind down, I find myself becoming more and more of a caffeine enthusiast. While a No-Doz or Diet Mt. Dew may put a little more pep in my step, the caffeine found in energy drinks, caffeine pills, and diet supplements can quickly result in an dangerous overdose in a young child.

Caffeine Overdose Presentation- Sympathomimetic Toxidrome

  • Tachycardia, dysrhythmia, hypertension
  • Diaphoresis, piloerection
  • Nausea, vomiting
  • Hyperthermia
  • Dilated pupils
  • Agitation, delusions, paranoia
  • Seizures, coma
  • Sometimes: Metabolic acidosis, hypokalemia
  • Rhabdo- muscle breakdown by Ca++ sequestration in the sarcoplasmic reticulum

Available Sources of Caffeine-

  • NoDoz- 200mg/tab
  • Excedrin 65mg/tab
  • Starbuck Double Shot 130mg/6.5oz
  • Monster Energy Drink 160mg/16oz
  • Caffeine Solution for Neonates with Apnea of Prematurity
  • So many more!

Toxic Doses

  • 15 mg/L- tachycardia, arrhythmia, HTN, seizure, vomiting, irritable, delusions, hallucinations (approx 1500 mg for an adult)
  • >80 mg/L- Coma or Death

Management- treat the symptoms (metabolic, cardiovascular, and neurologic)

  • IV Fluids
  • Anti-emetics
  • Sodium Bicarb if refractory metabolic acidosis
  • Benzos for severe agitation or seizure
  • PALS protocols for cardiac arrhythmias

Good Luck on the In-Service!

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