Caffeine, widely imbibed the world over in everything from tea and coffee to milk coke, is a stimulant. Like any stimulant, in enough quantity it can do serious damage to your body, and can even be lethal. A recent BMJ Case Report has highlighted just how dangerous it can be in large quantities, after a 26-year-old woman ended up in intensive care after ingesting a large quantity of the world's favorite psychoactive drug.
The woman, unnamed in the case report, took herself to London's Queen Elizabeth hospital after intentionally ingesting two heaped teaspoons of caffeine powder, which she'd ordered online. Some powdered caffeine products are illegal in the US, banned by the US Food and Drugs Association (FDA), but not in the UK
Mild caffeine overdoses of 1-2 grams can cause significant toxic effects, including tachycardia (a heart rate of over 100 beats per minute), disorientation, breakdown of skeletal muscle tissue, hallucinations, or mania. Larger overdoses – usually associated with ingesting too much caffeine from supplements – can result in death. Fatal overdoses have occurred after ingestions of over 5 grams of caffeine.
This patient had taken 20 grams in powder form. According to the FDA, this is the equivalent of around 56 cups of coffee all at once.
As you'd expect, when she arrived at the hospital she was in significant distress, reporting palpitations, sweating, anxiety, and difficulty breathing. She had an elevated heart rate of 109 beats per minute and low blood pressure. Her breathing became more rapid, and she became even more agitated. An ECG showed she was suffering from polymorphic ventricular tachycardia, while other tests showed metabolic acidosis, a serious electrolyte disorder where acid builds up in the body.
She was initially given electrolyte replacement for the metabolic acidosis, but her condition persisted and she was moved to intensive care. Here, she was sedated with fentanyl and paralyzed with rocuronium, and placed on an invasive ventilator. She was also administered activated charcoal, which binds to toxins in the gut, preventing the caffeine from being absorbed into the bloodstream.
Thankfully, with careful monitoring and treatment using magnesium for her heart rate, the woman came out of intensive care after a week and has made a good recovery under the care of a psychiatric team. She was lucky to survive the overdose, the doctors said. Tests showed her caffeine levels at 147.1mg/L, far higher than the 80mg/L that has been seen in fatal cases of caffeine ingestion. The doctors noted that as this measurement was taken hours after she took the caffeine, it could have been even higher.
"I found out about caffeine overdoses from an article in Daily Mail Australia about a teenager who had died after taking two teaspoons of caffeine powder," the patient told the medical team in the case report. "I went online and bought 1 kg of powdered caffeine for £29.99 with next day delivery. My family and I are shocked that you can buy such a dangerous amount of caffeine so easily and cheaply."