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)

- 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!

References