{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:00:05Z","timestamp":1790136005168,"version":"4.0.1"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2010,1,21]],"date-time":"2010-01-21T00:00:00Z","timestamp":1264032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2010,4]]},"abstract":"<jats:p>Caffeine is a natural alkaloid methylxanthine that is found in various plants such as coffee or tea. Symptoms of a severe overdose may present with hypokalemia, hyponatremia, ventricular arrhythmias, hypertension followed by hypotension, respiratory failure, seizures, rhabdomyolysis, ventricular fibrillation and finally circulatory collapse. A 21\u2010year\u2010old woman called for the ambulance herself soon after the ingestion of about 10,000\u2003mg of caffeine. At the arrival of the ambulance, the patient went into cardiac arrest almost immediately. After a total resuscitation period of 34\u2003min including seven counter\u2010shocks and 2\u2003mg epinephrine, the patient was stable enough to be transferred to the hospital. The patient soon went into VF again and received two more counter\u2010shocks and 1\u2003mg epinephrine and finally an intravenous bolus dose of 300\u2003mg amiodarone. The initial arterial blood gas showed pH at 6.47, lactate at 33\u2003mmol\/l and potassium level at 2.3\u2003mmol\/l. Unfortunately, no blood samples for caffeine analysis were taken. Three days after hospital admission, the patient developed myoclonus, which did not respond to medical treatment. Excessive intake of caffeine may produce arrhythmias and pronounced hypokalemia and ensuing ventricular fibrillation. In case of counter\u2010shock\u2010resistant VF, it can be necessary to give an early loading dose of amiodarone. Furthermore, it may be beneficial to replace the potassium as early as possible. Epinephrine and buffer solutions used during resuscitation may further decrease blood potassium levels and should be administrated cautiously. Epinephrine can be replaced by other vasopressor drugs, such as vasopressin without effects on \u03b2\u2010receptors.<\/jats:p>","DOI":"10.1111\/j.1399-6576.2009.02201.x","type":"journal-article","created":{"date-parts":[[2010,1,21]],"date-time":"2010-01-21T05:24:25Z","timestamp":1264051465000},"page":"521-523","source":"Crossref","is-referenced-by-count":67,"title":["A case of fatal caffeine poisoning"],"prefix":"10.1111","volume":"54","author":[{"given":"T.","family":"RUDOLPH","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"KNUDSEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,2,25]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"518","article-title":"Caffeine","volume":"145","author":"Abbott PJ.","year":"1986","journal-title":"a toxicological overview"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02245818"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.4.660"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2003.09.019"},{"key":"e_1_2_6_6_2","first-page":"571","article-title":"Massive caffeine ingestion resulting in death","volume":"31","author":"Mrvos RM","year":"1989","journal-title":"Vet Hum Toxicol"},{"key":"e_1_2_6_7_2","first-page":"67","article-title":"Fatal caffeine overdose","volume":"153","author":"Kerrigan S","year":"2005","journal-title":"two case reports"},{"key":"e_1_2_6_8_2","first-page":"228","article-title":"Acute caffeine ingestion fatalities","volume":"39","author":"Shum S","year":"1997","journal-title":"management issues"},{"key":"e_1_2_6_9_2","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S0022-3565(25)20409-8","article-title":"Caffeine and theophylline as adenosine receptor antagonists in humans","volume":"258","author":"Biaggioni I","year":"1991","journal-title":"J Pharmacol Exp Ther"},{"key":"e_1_2_6_10_2","volume-title":"Allgemeine und spezielle Pharmakologie und Toxikologie","author":"Forth W","year":"1998"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(97)70326-3"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2005.07.001"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)82139-0"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03259871"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1081\/CLT-120026526"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1399-6576.2009.02201.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1399-6576.2009.02201.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,16]],"date-time":"2025-02-16T17:19:27Z","timestamp":1739726367000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1399-6576.2009.02201.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,2,25]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2010,4]]}},"alternative-id":["10.1111\/j.1399-6576.2009.02201.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1399-6576.2009.02201.x","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,2,25]]}}}