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!

References

Jones, Maya A., and Elizabeth R. Alpern. "A 16-Month-Old Girl With Irritability After Ingesting White Pills." Pediatric emergency care 30.1 (2014): 69-71.

Wolk, Brian J., Michael Ganetsky, and Kavita M. Babu. "Toxicity of energy drinks." Current opinion in pediatrics 24.2 (2012): 243-251.