860 0340619991001893
Acute caffeine poisoning in a child P. G. Jorens 1, J. M. V a n H a u w a e r t 2, M. I. Selala 3, and P. J. C. S c h e p e n s 3
Department of 1Medicine, 3Pharmaceutical Sciences, Toxicology Unit, University of Antwerp (UIA), Universiteitsplein 1, B-2610 Wilrijk, Belgium 2Department of Paediatrics, General Hospital Sint Jozef, B-2300 Turnhout, Belgium Received April 17, 1991 / Accepted after revision May 17, 1991
Sir: Caffeine and theobromine are common constituents of beverages, food and a number of medications. However, only few cases of acute caffeine poisoning have been reported and the acute and chronic effects of caffeine ingestion in children are largely unknown. Recently, we observed a case of caffeine poisoning associated with the ingestion of a soured cocoa beverage. A healthy 5-year-old boy fell ill after sucking part of a bottle of cocoa beverage (chocolate drink) with a straw. Having noticed the unusual taste of the drink (it had been standing open 3 days outdoors), the mother immediately destroyed the contents. An hour later the child became agitated and was taken to hospital. On admission he was subcomatose with bilateral mydriasis, generalized muscular hypotonia and an increased heart rate of 115 beats/min. No additional abnormalities were observed and his E E G as well as biochemical and haematological data were normal. Glucose and 0.9% NaCI were administered intravenously, and 6 h later the clinical situation improved. He was discharged 24 h after admission in good health. Toxicological analysis of the boy's serum using gas chromatography-mass spectrometry revealed large amounts of caffeine and its dimethylxanthine metabolite, theobromine. No other toxins were detected. Serum caffeine level was 15.6 gg/ml and theobromine 3.5 gg/ml. Trace amounts of these products were also found in the rinsed beverage container. Caffeine is rapidly absorbed from the gastro-intestinal tract [2]. Signs of caffeine overdose include nausea, agitation, restlessness, muscular hyper- or hypotonia, fluctuating coma and other signs of increased a- and ~stimulation of the sympathetic nervous system such as tachycardia and hypertension [2]. Mydriasis observed in our patient has not been previously reported. Serum caffeine levels producing toxicity vary. Sullivan reported one case of central nervous system agitation and coma in a 12-month-old girl with a serum cafOffprint requests to: P. J. C. Schepens
feine level of 46 gg/m [3]. In neonates, acute symptoms occurred with serum caffeine levels ranging from 10.4 gg/ml to 190 ~tg/ml [1]. Levels of 17 ~tg/ml are known to cause irritability and tonic posturing [1]. Our patient was treated with intravenously administered glucose resulting in quick recovery. Glucose is known to antagonize the excitatory action of caffeine and theobromine on the nervous system [4]. The actual source of caffeine and theobromine in this case may be questioned. Chocolate drinks may contain small amounts of these substances. That the drink had been left open for 3 days or had developed a "spoiled" taste would definitely not increase its alkaloid content. However, it may be that an error occurred during manufacture or that the child had also consumed other food or beverages containing caffeine. Nevertheless, data obtained in this case suggest that one has to consider caffeine poisoning in children with mydriasis, agitation or coma.
References
1. Banner W, Czajka PA (1980) Acute caffeine overdose in the neonate. Am J Dis Child 134 : 495-498 2. Ellenhorn JMJ, Barceloux DG (1988) Over-the counter products caffeine. In: Ellenhorn MJ, Barcelonx DG (eds) Medical toxicology; diagnosis and treatment of human poisoning. Elsevier, New York, pp 499-599 3. Sullivan J (1977) Caffeine poisoning in an infant. J Pediatr 90 : 1022-1023 4. Tarka SM (1982) The toxicology of cocoa and methylxanthines: a review of the literature. CRC Crit Rev Toxicology 9:275-312
Acute caffeine poisoning in a child P. G. Jorens 1, J. M. V a n H a u w a e r t 2, M. I. Selala 3, and P. J. C. S c h e p e n s 3
Department of 1Medicine, 3Pharmaceutical Sciences, Toxicology Unit, University of Antwerp (UIA), Universiteitsplein 1, B-2610 Wilrijk, Belgium 2Department of Paediatrics, General Hospital Sint Jozef, B-2300 Turnhout, Belgium Received April 17, 1991 / Accepted after revision May 17, 1991
Sir: Caffeine and theobromine are common constituents of beverages, food and a number of medications. However, only few cases of acute caffeine poisoning have been reported and the acute and chronic effects of caffeine ingestion in children are largely unknown. Recently, we observed a case of caffeine poisoning associated with the ingestion of a soured cocoa beverage. A healthy 5-year-old boy fell ill after sucking part of a bottle of cocoa beverage (chocolate drink) with a straw. Having noticed the unusual taste of the drink (it had been standing open 3 days outdoors), the mother immediately destroyed the contents. An hour later the child became agitated and was taken to hospital. On admission he was subcomatose with bilateral mydriasis, generalized muscular hypotonia and an increased heart rate of 115 beats/min. No additional abnormalities were observed and his E E G as well as biochemical and haematological data were normal. Glucose and 0.9% NaCI were administered intravenously, and 6 h later the clinical situation improved. He was discharged 24 h after admission in good health. Toxicological analysis of the boy's serum using gas chromatography-mass spectrometry revealed large amounts of caffeine and its dimethylxanthine metabolite, theobromine. No other toxins were detected. Serum caffeine level was 15.6 gg/ml and theobromine 3.5 gg/ml. Trace amounts of these products were also found in the rinsed beverage container. Caffeine is rapidly absorbed from the gastro-intestinal tract [2]. Signs of caffeine overdose include nausea, agitation, restlessness, muscular hyper- or hypotonia, fluctuating coma and other signs of increased a- and ~stimulation of the sympathetic nervous system such as tachycardia and hypertension [2]. Mydriasis observed in our patient has not been previously reported. Serum caffeine levels producing toxicity vary. Sullivan reported one case of central nervous system agitation and coma in a 12-month-old girl with a serum cafOffprint requests to: P. J. C. Schepens
feine level of 46 gg/m [3]. In neonates, acute symptoms occurred with serum caffeine levels ranging from 10.4 gg/ml to 190 ~tg/ml [1]. Levels of 17 ~tg/ml are known to cause irritability and tonic posturing [1]. Our patient was treated with intravenously administered glucose resulting in quick recovery. Glucose is known to antagonize the excitatory action of caffeine and theobromine on the nervous system [4]. The actual source of caffeine and theobromine in this case may be questioned. Chocolate drinks may contain small amounts of these substances. That the drink had been left open for 3 days or had developed a "spoiled" taste would definitely not increase its alkaloid content. However, it may be that an error occurred during manufacture or that the child had also consumed other food or beverages containing caffeine. Nevertheless, data obtained in this case suggest that one has to consider caffeine poisoning in children with mydriasis, agitation or coma.
References
1. Banner W, Czajka PA (1980) Acute caffeine overdose in the neonate. Am J Dis Child 134 : 495-498 2. Ellenhorn JMJ, Barceloux DG (1988) Over-the counter products caffeine. In: Ellenhorn MJ, Barcelonx DG (eds) Medical toxicology; diagnosis and treatment of human poisoning. Elsevier, New York, pp 499-599 3. Sullivan J (1977) Caffeine poisoning in an infant. J Pediatr 90 : 1022-1023 4. Tarka SM (1982) The toxicology of cocoa and methylxanthines: a review of the literature. CRC Crit Rev Toxicology 9:275-312
