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Which of hemodialysis and direct hemoperfusion is more recommended for treating severe caffeine poisoning?

Published:March 08, 2019DOI:https://doi.org/10.1016/j.ajem.2019.03.010
      In recent years, the number of patients intoxicated with caffeine, a xanthine derivative (1,3,7-trimethylxanthine), has increased in Japan, and severe or fatal cases have been reported [
      • Kamijo Y.
      • Takai M.
      • Fujita Y.
      • Usui K.
      A retrospective study on the epidemiological and clinical features of emergency patients with large or massive consumption of caffeinated supplements or energy drinks in Japan.
      ]. Theophylline is another xanthine derivative (1,3-dimethylxanthine) that shares a similar pharmacokinetic profile with caffeine. For the treatment of severe theophylline poisoning, hemodialysis (HD) is the preferred recommended extracorporeal treatment, whereas charcoal hemoperfusion (CHP) is acceptable if HD is not available [
      • Ghannoum M.
      • Wiegand T.J.
      • Liu K.D.
      • Calello D.P.
      • Godin M.
      • Lavergne V.
      • et al.
      EXTRIP workgroup. Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup.
      ]. Thus, these hemopurification methods may also be recommended for treating severe caffeine poisoning. However, no studies have addressed whether HD or CHP is superior for treating severe caffeine poisoning through an assessment of caffeine clearance (CL). Here we discuss two cases of severe caffeine poisoning; one patient was treated by HD and the other by CHP.

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