Caffeine toxicity secondary to street drug ingestion

Confirmed glyburide poisoning from ingestion of "street Valium"

BACKGROUND

Pharmaceuticals with little to no abuse potential are often sold surreptitiously as drugs of abuse on the street. Anecdotally, sulfonylureas are suspected to be commonly sold as "street Valium."

CASE REPORTS

Two patients presented with altered mental status and persistent hypoglycemia requiring continuous intravenous dextrose, in the context of suspected attempted benzodiazepine abuse. Supratherapeutic glyburide levels of 1198 and 647 ng/mL were measured in these patients.

CONCLUSIONS

These are two cases of glyburide poisonings from ingestion of "street Valium" that have been confirmed by laboratory testing.

First-Onset Seizure After Use of an Energy Drink [corrected]

The health consequences of energy drink use in adolescents are unknown. We discuss an adverse event in an adolescent who presented to the emergency department with his first-ever seizure after consumption of 5-Hour Energy. We review the typical presentation of caffeine toxicity, as well as the importance of screening for energy drink use in adolescents with appropriate clinical findings. We pay particular attention to the identification of energy drink-related adverse events in the emergency department and the need for subsequent reporting to the Food and Drug Administration. To our knowledge, this is the first reported case of an adolescent presenting with a new-onset seizure associated with energy drink use.

Caffeine overdose in an adolescent male

A 16 year old male who ingested an estimated 6-8 grams of caffeine is described. Caffeine is commonly thought to be harmless, but its wide availability has promoted abuse. This patient manifested many of the adverse effects seen in acute caffeine ingestion including hypokalemia, elevated blood glucose, tachycardia, bigeminy and agitation. Respiratory alkalosis and chest pain, which have not been previously reported to our knowledge in caffeine overdose, were also noted in this patient. Three serum caffeine levels were analyzed and an abnormally long elimination half-life of approximately 16 hours was calculated from the results.

Misrepresentation of stimulant street drugs: a decade of experience in an analysis program

The findings of the Los Angeles County Street Drug Identification Program over the period from 1971 to 1980 for analysis of 1163 samples of street drugs represented as stimulants are presented. Of the 614 alleged cocaine samples, cocaine was found to be absent in 19.2%, found combined with stimulant substitutes in 22.5%, and found by itself in 58.3% of these samples. The validity for 473 alleged amphetamine samples was only 27.1%, with 23.0% of samples found to contain stimulant substitutes along with amphetamine, and 49.9% of the samples lacking any of the alleged drug. Seventy-six alleged methamphetamine samples showed 32.9% validity, with 3.9% of samples having mixtures of alleged drug and substitutes, and 63.2% of samples lacking any methamphetamine. A total of 15 different stimulant substitutes were found in 74 combinations. Caffeine, ephedrine, lidocaine, and procaine were the commonest substitutes.

Toxicokinetics of caffeine elimination in an infant

The kinetics of caffeine elimination were followed in a ten month old female acutely intoxicated on a street form of the drug. Urine drug screening by gas chromatography-mass spectrometry also showed the presence of ephedrine, phenylpropanolamine, caffeine, theophylline and theobromine. Blood analyses using high pressure liquid chromatography gave evidence for the presence of theobromine, theophylline, caffeine and 1,7-dimethylxanthine. Sequentially taken blood samples determined that the initial stage of caffeine elimination was nonlinear. The Vmax = 27.6 micrograms/ml/hr and Km = 284.6 micrograms/ml. At a plasma level of approximately 30 micrograms/ml the elimination became first order with ke = 0.097 hr-1 and t 1/2 = 7.1 hr. The metabolic generation of theophylline and its elimination were also studied. Theophylline ke = 0.069 hr-1 and t 1/2 = 10.0 hr. Elimination of both drugs was anomalously long for a child of this age.

Caffeine and human behavior: arousal, anxiety, and performance effects

A review of the recent literature shows the role of caffeine in the physiology, mood, and behavior of persons to be a complex one including changes in arousal, anxiety, and performance. Questions are raised as to what degree the physiological effects of caffeine are due to central nervous system stimulation and/or result from the release of catecholamines. Anxiety resulting from both high levels of caffeine (caffeinism) and caffeine withdrawal plus an association between caffeine and depression are discussed. Performance effects are mixed, with both increases and decreases reported. Effects on mental tasks are related to personality variables. The possible role of differences in initial sensitivity, adaptation to caffeine, and/or interactions with nicotine and alcohol is discussed. The present paper reviews these studies, discusses their implications for both clinical and experimental work, summarizes the major unresolved issues, and makes suggestions for new and continuing areas of research.