Caffeine Overdose Causes Severe Erosive Esophagitis

The intentional ingestion of a bottle of caffeine tablets in an apparent suicide attempt caused severe erosive esophagitis and acute renal failure in a 43-year-old man, according to a case report published in Cureus.

“This case highlights the risk of concurrent renal and gastrointestinal injuries after ingesting excessive caffeine tablets,” wrote corresponding author Justice S. Arhinful, MD, of the University of Missouri School of Medicine and Lester E. Cox Medical Center South, Springfield, Missouri, and coauthors. “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.”

The patient, who had a past medical history of paranoid schizophrenia, presented to the emergency department with throat pain, retrosternal chest pain, dysphagia/odynophagia, nausea, and vomiting 2 days after ingesting an estimated 30 g of caffeine. A urine drug screen was negative, but the man’s blood caffeine level was not assessed.

The patient received hemodialysis for rhabdomyolysis and acute renal failure while hospitalized. His renal failure gradually recovered over 3 months of intermittent hemodialysis, the authors reported.

On day 7 of his hospital stay, the man underwent an esophagogastroduodenoscopy due to persistent esophageal symptoms despite receiving oral famotidine 20 mg daily. The diagnostic procedure revealed severe erosive esophagitis. Following the initiation of a proton pump inhibitor (pantoprazole 40 mg intravenously twice daily), his esophageal symptoms improved significantly, according to the report.

“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,” the authors wrote.

Reference:
Arhinful JS, Arhinful B, Akins TA, Hossain S. Caffeine-induced severe erosive esophagitis. Cureus. 2021;13(7):e16253. doi:10.7759/cureus.16253