Caffeine OD · Rescue Academy

Caffeine OD

Last P2 lab there was a good discussion about a patient who overdosed on caffeine. The patient's HR was 190, in SVT. How should this be managed?

Supportive care first → oxygen, IV access, cardiac monitoring.
Benzodiazepines (e.g., midazolam, diazepam, lorazepam) → first-line to reduce sympathetic surge, agitation, and rate.
Avoid adenosine or beta-blockers initially in massive caffeine overdose, because underlying mechanism is not a pure AV node reentry — and abrupt AV nodal block may worsen instability.
Calcium channel blockers (diltiazem, verapamil) slow AV node conduction, but they don’t address the underlying catecholamine storm and can drop blood pressure in an already unstable overdose patient.
Fluids → for perfusion support.
Transport to ED → may need activated charcoal (if recent ingestion), antiarrhythmics (like esmolol), or even dialysis in severe cases.