Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

Vojnosanitetski Pregled

卷:69

关键词: caffeine;    poisoning;    cosmetic techniques;    risk assessment;   

DOI  :  10.2298/VSP1208707P

来源: DOAJ

【 摘 要 】

Introduction. Caffeine is indicated in the treatment of migraine headaches,as well as neonatal apnea and bradycardia syndrome. In mild poisoning, themost prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety andheadache. In more severe cases, symptoms consist of heart rythymabnormalities, myocardial infarction and seizures. Due to its commonlipolytic effect, caffeine is used in mesotherapy, usually in combinationwith drugs of similar effect. We presented a patient with acute iatrogeniccaffeine poisoning. Case report. A 51-year-old woman, with preexistinghypertension and hypertensive cardiomyopathy was subjected to cosmetictreatment in order to remove fat by intradermal caffeine injections. Duringthe treatment the patient felt sickness, an urge to vomit, and a pronounceddeterioration of general condition. Upon examination, the patient exhibitedsomnolence, hypotension and nonsustained ventricular tachycardia, which wassufficient enough evidence for further hospitalization. On admission to theintensive care unit the patient was anxious with increased heart rate,normotensive, with cold, damp skin, and visible traces of injection siteswith surrounding hematomas on the anterior abdominal wall. Paroxysmalsupraventricular tachycardia (PSVT) on electrocardiographic monitoring wasfound. The laboratory analysis determined a lowered potassium level of 2.1mmol/L (normal range 3,5 - 5.2 mmol/L), and a toxicological analysis (liquidchromatography with ultraviolet detection) proved a toxic concentration ofcaffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L). Onapplication of intensive therapy, antiarrhythmics, and substitution ofpotassium, as well as both symptomatic and supportive therapy, there was asignificant recovery. The patient was discharged without any sequele withinfour days. Conclusion. A presented rare iatrogenic acute caffeine poisoningoccured due to massive absorption of caffeine from the subcutaneous adiposetissue into the circulation when injected directly into the tiny bloodvessels, as evidenced by hematoma formation. Poisoning manifestations wereregistered in gastrointestinal, CNS (anxiety, somnolence) and cardiovascular(hypotension, ventricular tachycardia and nonsustained PSVT) system. In thisera of mesotherapeutic treatment promotion, one should keep in mind toxicprevention, with application being carried out exclusively in a specializedinstitution

【 授权许可】

Unknown