Abstract
Caffeine is one of the most frequently used stimulants worldwide. It is, therefore, subject to frequent intentional and unintentional misuse. However, severe erosive esophagitis due to acute caffeine overdose is extremely rare. We report the case of a 43-year-old male with a past medical history of paranoid schizophrenia admitted to our hospital with esophageal symptoms (throat pain, retrosternal chest pain, dysphagia/odynophagia, nausea, and vomiting) two days after ingesting a bottle of caffeine pills containing about 30 g of caffeine in a suicide attempt. He was found to have rhabdomyolysis and acute renal failure warranting hemodialysis. Esophagogastroduodenoscopy done due to persistent retrosternal chest pain, dysphagia, odynophagia, and nausea despite being on oral famotidine 20 mg daily revealed severe erosive esophagitis. This case highlights the risk of concurrent renal and gastrointestinal injuries after acute ingestion of an excessive amount of caffeine tablets. Our experience suggests that in patients of caffeine overdose with persistent esophageal symptoms such as odynophagia, dysphagia, and retrosternal chest pain, endoscopic evaluation is advisable to rule out drug-induced esophagitis.
Highlights
Caffeine (1,3,7-trimethylxanthine) is a ubiquitous natural xanthine alkaloid found in coffee, cocoa, tea, and kola nuts [1,2,3]
We report the case of a 43-year-old male with a past medical history of paranoid schizophrenia admitted to our hospital with esophageal symptoms two days after ingesting a bottle of caffeine pills containing about 30 g of caffeine in a suicide attempt
To the best of our knowledge, only one case of esophageal injury secondary to an overdose of caffeine tablets has been reported in the English literature; three other cases of esophageal injury secondary to caffeine overdose have been reported in Japanese [6]
Summary
Caffeine (1,3,7-trimethylxanthine) is a ubiquitous natural xanthine alkaloid found in coffee, cocoa, tea, and kola nuts [1,2,3]. A 43-year-old male with a past medical history of paranoid schizophrenia presented to the emergency department (ED) with esophageal symptoms (throat pain, dysphagia/odynophagia, nausea, and vomiting) two days after ingesting a bottle of caffeine pills (about 30 g of caffeine) in an apparent suicide attempt His vital signs on presentation to the ED included a blood pressure of 106/70 mmHg, heart rate of 136 beats per minute, body temperature of 98.5°F, and saturation of 91% on room air. Pathology reports of the gastric biopsy were consistent with mild chronic inactive gastritis, while that of the gastric subepithelial lesion was consistent with leiomyoma His esophageal symptoms markedly improved following the initiation of proton pump inhibitor (pantoprazole 40 mg IV twice daily). Our experience suggests that for patients who have ingested excessive caffeine tablets, endoscopic evaluation is advisable in the setting of persistent esophageal symptoms to evaluate for chemical esophagitis
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