Circulatory and pulmonary failure after primarily survived caffeine intoxication

Caffeine is an easy-to-use stimulant, which can also be bought as a pure substance in large quantities. The toxic effect after the intake of a large dose can have devastating consequences. We report of a 35-year-old female patient who inadvertently took a lethal dose of caffeine powder (9 g) and had to undergo reanimation a short time later. After prolonged preclinical resuscitation, she was admitted to the hospital with severe lactic acidosis and was reanimated for further 100 minutes. The caffeine effect resulted in a severe, non-defibrillatable ventricular tachycardia, which could only be converted by the administration of lidocaine. A stable sinus rhythm was then maintained by continuous lidocaine application. Levosimendan was successfully applied in combination with noradrenaline to stabilize the patient's blood circulation. After initial stabilization within the first ten hours after ingestion, lactate acidosis with circulatory failure and an acute respiratory distress syndrome reoccurred, so that the patient died 23 hours after caffeine intake despite maximum therapy and the use of an extracorporeal membrane oxygenation.