Intentional caffeine poisoning in an infant.

Abstract

Caffeine toxicity in pediatric patients is uncommon. Child abuse by poisoning is being reported with increasing frequency. We present a case of intentional caffeine poisoning in a 5-week-old infant and review treatment. This infant later suffered fatal physical abuse. There is a similar case of physical abuse and caffeine poisoning in the forensic pathology literature,1 but this is the first such case reported in the pediatrics literature. A 5-week-old Native American boy was referred for evaluation of persistent tachycardia. He was born at 37 weeks' gestation by second cesarean section to a 22-year-old gravida 3, para 2 mother. The pregnancy was significant for gestational diabetes mellitus requiring insulin. The neonatal course was complicated by hypoglycemia and the presence of mild hypertrophic cardiomyopathy, both attributable to maternal diabetes. The infant was discharged home at 3 days of age and had since been healthy, breastfeeding, and growing well. On the day of admission, the infant was left in his father's care while the mother went to work. Reportedly he had been fine earlier in the day, but on the mother's return home, she noticed that he was agitated and irritable. The father attributed the change to a 1-year-old sibling having sat on the child's chest. There was no reported fever, vomiting, diarrhea, or respiratory symptoms. Initial examination revealed a well-developed, well-nourished 5-week-old infant. Weight, length, and head circumference were at the 75th, 90th, and 95th percentiles for age, respectively. His heart rate ranged from 205 to 237 beats per minute, his respiratory rate was 60 breaths per minute, and his blood pressure was 118/65 mm Hg. His rectal temperature was initially 37.9°C but increased to 39.5°C within 4 hours of presentation. There were no outward signs of trauma. Breath sounds were clear and equal, and cardiac examination was notable for a grade …