While caffeine is used for stimulant and mood-elevating effects in drinks such as coffee, it also has been used to treat neonatal apnea and headaches in combination with other analgesics. Ĭaffeine is a methylxanthine similar to theophylline and theobromine. Fioricet® is primarily intended as treatment for tension headaches.
#CAFFEINE OVERDOSE HOME TREATMENT PATCH#
Due to concerns about the patient’s reported fentanyl patch ingestion and the lack of knowledge regarding possible extended-release formulations, whole bowel irrigation with polyethylene glycol-balanced electrolyte solution was also initiated.įioricet® (Watson Laboratories, Inc) is a combination tablet consisting of 40 mg of caffeine (1,3,7–trimethylxanthine), 325 mg of acetaminophen, and 50 mg of butalbital (5-allyl-5-isopropylbarbituric acid). About 90 min after arrival (3 h after ingestion), the patient began having massive diuresis, producing 5,800 cc of urine over 1 h. Due to the reported large ingestion of acetaminophen and some initial uncertainty about the time of ingestion, an IV N-acetylcysteine (NAC) infusion was started according to the 21-h protocol, prior to obtaining serum acetaminophen level results. Activated charcoal 50 g was administered via orogastric tube. An orogastric tube and Foley catheter were both inserted, with a large volume (700 cc) of dark-colored urine quickly filling the Foley bag.
#CAFFEINE OVERDOSE HOME TREATMENT SKIN#
The patient was noted to be shivering prior to being fully exposed, and her skin was warm and dry, revealing no signs of traumatic injuries.Īn ECG revealed a normal sinus rhythm at 86 beats per minute with a prolonged QTc interval (504 ms). The patient’s pupils were 1–2 mm in diameter and sluggishly reactive to light. On further examination, she had palpable distal pulses, and her abdomen was soft and non-tender.
The patient’s ventilation improved with jaw thrust, but, due to increased secretions, she was intubated within 10 min of ED arrival using etomidate and succinylcholine. Auscultation of her chest revealed clear but bilaterally diminished breath sounds and a regular cardiac rhythm without murmurs, rubs, or gallops. On arrival to the ED, the patient was unconscious with the following vital signs: blood pressure, 98/54 mmHg pulse, 72 beats/min respiratory rate, 14 breaths/min and pulse oximetry, 100 % on a non-rebreather mask. Prehospital treatment included naloxone 4 mg IV without any noticeable clinical response, insertion of a nasal trumpet, and initiation of bag-valve-mask ventilation. The source of the fentanyl and the strength and formulation of the oxycodone were not recorded.
EMS personnel removed a fentanyl patch (unknown strength) from her skin. A call to the patient’s pharmacy by ED staff revealed that the patient had her prescription for butalbital/acetaminophen/caffeine tablets refilled 5 days earlier and that she had convinced the pharmacist to override the refill amount to dispense 540 tablets according to the pharmacist, the patient stated she was going on a trip to Italy and needed a 6-month supply. The patient’s husband reported they had had a fight, and he went down to the basement when he came back upstairs, he found the patient unconscious with an empty pill bottle. A 40-year-old woman with no previous medical problems presented to the Emergency Department (ED) 2 h after ingesting an unknown amount of Fioricet® (butalbital/acetaminophen/caffeine), oxycodone, and fentanyl patches about 90 min prior to emergency medical service (EMS) dispatch.
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