Caffeine Intoxication: An Analysis of Published Case Reports, 1883–2023.

Background: Many case reports of acute caffeine intoxication have been published, but there have been hardly any systematic data analyses, nor have there been any prospective studies, representative epidemiologic studies, or guideline recommendations. In this review, we aim to describe the clinical entity of acute caffeine intoxication and its treatments to date on the basis of published case reports.

Methods: This review is based on pertinent case reports retrieved by a search in the PubMed, Google Scholar, and Semantic Scholar databases covering the period 1851-2023 and employing the keywords "caffeine intoxication," "caffeine poisoning," and "caffeine overdose."

Results: 216 published individual cases were analyzed. The median caffeine intoxication dose was 12 g (0.05-106 g), and the median serum caffeine concentration was 160 mg/L (15.6-1560 mg/L). The intoxication was deliberate with suicidal intent in 40% of cases, accidental in 22%, and a treatment error in 6%. 21% of the accidental intoxications were in minors. Convulsions and wide-complex tachycardias due to intoxication were associated with a worse outcome, and extracorporeal hemodialysis appears to be a safe and effective way to eliminate caffeine, with a better survival rate even after severe intoxication. Doses of 5-10 g of caffeine can be lethal.

Conclusion: This is the largest analysis of caffeine intoxications ever carried out to date, yet no definitive treatment recommendations can be derived from it. Caffeine elimination by hemodialysis can be considered if the quantity ingested is potentially lethal, or in cases with a severe clinical course.