Fatal caffeine overdose: useful paper despite BuzzFeed-worthy title

This article is classic example of scientific bait and switch, a deceptive tactic not dissimilar to the use of “click bait” by websites like BuzzFeed. The subtitle promises “Fatal Caffeine Intoxication: A Series of Eight Cases . . .” But by the end of the introduction this has been walked to back “eight fatal cases of caffeine intoxication-related deaths,” a concept that is hopelessly vague and undefined. The way the authors use the term, a man who gets hit by a truck leaving Starbucks after drinking two Vente cappuccinos could be considered a caffeine-related death. The authors’ attitude seems to be: Causation? We don’t need no stinkin’ causation! In fact, a careful analysis of these cases, from the Office of the Chief Medical Examiner of Maryland, reveals that only 3 of these 8 cases (numbers 5,6 and 8) are convincingly caused by caffeine overdose. In the others, the caffeine level was lower than the generally accepted lethal concentration of 80 mg/L and/or other drugs were possibly involved (case #4 had a lethal level of butalbital). However, the paper may be worth perusing since, as illustrated by the clip above, the availability of concentrated caffeine powders may mean that we will be seeing more cases of significant overdose. Here are some key take-home points from the discussion section: Caffeine is rapidly and completely absorbed from the GI tract, with peak levels 30-60 minutes after ingestion. Through its actio...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical caffeine toxicity cardiotoxicity fatality Source Type: news

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Source: Journal of Toxicology and Environmental Health Part A - Category: Environmental Health Authors: Source Type: research
Publication date: Available online 10 October 2020Source: American Journal of Kidney DiseasesAuthor(s): Ibironke W. Apata, Sarah Kabbani, Alicia M. Neu, Tamara M. Kear, Erika M.C. D’Agata, David J. Levenson, Alan S. Kliger, Lauri A. Hicks, Priti R. Patel, authors constitute the ASN and CDC Antibiotic Stewardship White Paper Writing Group
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
CONCLUSION: We demonstrate that, compared to N-acetylcysteine alone, co-administration of glycyrrhizin decreases the liver necrosis score and improves survival in a murine model of acetaminophen-induced liver injury. Our study opens a potential new therapeutic pathway in the prevention of acetaminophen hepatotoxicity. PMID: 33033567 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Authors: Tsujioka S, Nozoe M, Kawano Y, Suematsu N, Kubota T Abstract A 70-year-old woman with situs inversus totalis underwent catheter ablation for atrial fibrillation and atrial flutter. Although her morphologic left atrium (LA) was enlarged, we performed cryoballoon ablation and liner radiofrequency ablation of the cava-tricuspid isthmus without mapping atrial arrhythmias. However, a different form of atrial tachycardia (AT) recurred. We performed catheter ablation a second time using a three-dimensional electroanatomic mapping system. AT was not terminated by the liner ablation at the roof of morphologic LA an...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
​BY KATIE TAUSCH, MD; ELAINA CLARK; KIMBERLY KRESS GETZINGER, MD; SHANNA C. JONES, MDA 25-year-old man with a history of depression and narcotic abuse presented to the ED seven hours after ingesting 200 loperamide 2 mg tablets. He was found unresponsive at home. He was somewhat somnolent but oriented on arrival.His blood pressure was 76/43 mm Hg, pulse rate was 62 bpm, respiratory rate was 20 bpm, temperature was 35.7°C orally, and SpO2 was 98% on room air. His physical examination was otherwise normal. He said he took the loperamide "to get high and relax." He normally took 150–200 loperami...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Conclusion. Modafinil is a central nervous system stimulant with well-established effectiveness in the treatment of narcolepsy and shift-work sleep disorder. There is conflicting evidence about the benefits of modafinil in the treatment of fatigue and EDS secondary to TBI. One randomized, controlled study states that modafinil does not significantly improve patient wakefulness, while another concludes that modafinil corrects EDS but not fatigue. An observational study provides evidence that modafinil increases alertness in fatigued patients with past medical history of brainstem diencephalic stroke or multiple scleros...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue Review excessive daytime sleep fatigue head injury modafinil stroke TBI traumatic brain injury Source Type: research
Alexander Gettler Once again, last year’s outstanding examples of long-form journalism dealing with topics related to medical toxicology were dominated by coverage of the opioid crisis, its origins and the resulting carnage. The must-read article of the year was “The Family That Built a Empire of Pain,” Patrick Radden Keefe’s massive history of the Sacklers, one of America’s richest clans, much of whose wealth comes from their ownership of Purdue Pharma and the marketing and distribution of Oxycontin. The article, which appeared in the New Yorker, notes that the clan’s patriarch, Ar...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical 2017 Alexander awards opioids Purdue Pharma Sackler Source Type: news
Conclusion and Recommendations More intervention-based clinical trials are needed to provide a strong alternative candidate therapy for management of opiate use disorder. Buprenorphine, although a promising candidate, should be researched more regarding treatment retention and patient satisfaction before any conclusions can be made regarding its standard use for opiate substitution maintenance treatment of pregnant patients with opiate use disorder. Heroin-assisted treatment still cannot be considered in opiate addicts refractory to MMT; more data should be collected regarding efficacy in larger participant populations un...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue General Review buphernorphin heroin methadone opiate opiate addiction treatment withdrawal Source Type: research
4 out of 5 stars Flumazenil, naloxone and the ‘coma cocktail’ Sivilotti MLA Br J Clin Pharmacol 2015 Aug 7 [Epub ahead of print] Abstract This very smart paper reviews factors affecting the clinical use of two antidotes that reliably reverse  coma caused by two major classes of poisons: flumazenil for benzodiazepines, and naloxone for opiates. Both these antidotes are specific, rapid-acting, short-lived, and titratable. However, significant adverse effects have been associated with each of them. Unwise or overly aggressive administration of flumazenil can cause acute benzodiazepine withdrawal, agitati...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical antidote benzodiazepine coma cocktail flumazenil naloxone opiate Source Type: news
The objective was to assess the risk of (S)AEs associated with use of flumazenil in patients with impaired consciousness due to known or suspected benzodiazepine overdose. Studies included in the meta‐analyses were identified by literature search in Medline, Cochrane Library and Embase using combinations of the words flumazenil, benzodiazepines, anti‐anxiety agents, poisoning, toxicity and overdose. Randomised clinical trials (RCTs) in verified or suspected benzodiazepine overdose patients comparing treatment with flumazenil versus placebo were included. Pre‐defined outcome measures were AEs, SAEs and mortality. Thir...
Source: Basic and Clinical Pharmacology and Toxicology - Category: Drugs & Pharmacology Authors: Tags: Mini Review Source Type: research
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