Toxic Dose:
The lethal oral dose for caffeine is 10g for adults, which equals 150-200mg per kg of body weight. For children, toxicity begins at 35mg per kg body weight. Coffee normally contains 50-200mg of caffeine per cup, while tea contains 40-100mg per cup. Sleep suppressants usually contain 200mg of caffeine per pill.
Mechanism of Toxicity
Caffeine works by inhibiting adenosine receptors, which regulate heartbeat (decrease heart rate). When overdosed, caffeine stimulates beta-1 ( increased heart rate and force) and beta-2 (relax small muscle of GI and urogenital tract) receptors. The stimulation occurs through release of two endogenous catecholamines, epinephrine and norepinephrine.
Caffeine is absorbed quickly in the body. The elimination half life depends on the health status and age of the individual. It ranges between 3 hours in healthy smokers, 10 hours in nonsmokers, and 24 hours in infants. After overdose, the elimination half life may increase to up to 15 hours in adults.
Clinical Presentation of Caffeine Toxicity
Chronic excessive intake of caffeine can lead to serious toxicity with relatively low blood caffeine levels when compared to a single high dose. The clinical presentations for acute and chronic toxicity show little variation. Chronic intake of high doses leads to so-called “caffeinism”, which is characterized by nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia, palpitations, and hyperreflexia. Acute caffeine poisoning first causes anorexia, tremor and restlessness. Secondary symptoms are nausea, vomiting, tachycardia and confusion. Delirium, seizures, hypokalemia, hyperglycemia, supraventricular and ventricular tachyarrythmias (fast and irregular heart beat) and diastolic hypotension due to beta 2 mediated vasodialation (leads to increased pulse pressure) are other possible symptoms.
When diagnosing, caffeine toxicity must be differentiated from Theophylline toxicity because of similar symptoms. Theophylline is a drug used for treating asthma, bronchospasm, congestive heart failure, and neonatal apnea. Serum levels of 80mg caffeine per liter are found to be lethal for adults. In coffee drinkers, 1-10mg per liter is a normal range for caffeine blood levels.
Treatment of Caffeine Toxicity:
In emergencies, measures should be taken to keep the airway open. If present, seizures and hypotension should be treated. Heart rate should be monitored using EKG for at least 6 hours. Beta blockers can be used to reduce the effects of caffeine toxicity.
Activated charcoal should be used for decontamination at home. In a hospital setting, gastric emptying may be performed if deemed necessary after activated charcoal administration. Repeated use of activated charcoal can be used to enhance the elimination of caffeine.