ACUTE CAFFEINE INTOXICATION AFTER INGESTION OF A POTENTIALLY LETHAL AMOUNT OF COFFEE - A CASE-REPORT

A 27 year-old deeply unconscious male patient with shallow spontaneous respiration was admitted to hospital following an epileptoid convulsion with a tentative diagnosis of cerebral trauma. On admission he was noted to have hyperpyrexia, tachycardia and hypertension. The clinical and laboratory findings pointed to intoxication. Aspiration of the stomach produced a large amount of coffee grounds, but not tablets or other poison. The plasma caffeine level was 29 mug/ml, which is potentially lethal. Therapy was commenced with a beta-blocker, an anticonvulsive drug and an antipyretic, and supportive symptomatic measures were undertaken. After 12 hours the patient was fully conscious, orientated and cooperative. He subsequently admitted having ingested about 500 g ground coffee with the intention of obtained a ''high'' state of drug intoxication, which he had successfully achieved on previous occasions with a smaller amount of coffee and without complications. The clinical picture was consistent with the expected signs of caffeine intoxication whereby the central effects of the substance remain to be clarified. This appears to be the first report of caffeine misused in this manner. In cases of intoxication with convulsions of uncertain aetiology, caffeine poisoning should be considered in the differential diagnosis.