Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

Abstract

Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. Case report. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT) on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L), and a toxicological analysis (liquid chromatography with ultraviolet detection) proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L). On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. Conclusion. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the subcutaneous adipose tissue into the circulation when injected directly into the tiny blood vessels, as evidenced by hematoma formation. Poisoning manifestations were registered in gastrointestinal, CNS (anxiety, somnolence) and cardiovascular (hypotension, ventricular tachycardia and nonsustained PSVT) system. In this era of mesotherapeutic treatment promotion, one should keep in mind toxic prevention, with application being carried out exclusively in a specialized institutio

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“…1). 25,35,39–66 A 43.3% majority of articles (13 of 30) were published from South America. The next 36.7% of articles (11 of 30) were published from Europe.…”

“…In a 2012 case study, a 51-year-old woman developed severe acute caffeine poisoning following intradermal caffeine injections. 25 In 2019, a woman presented with "violaceous, painful, suppurative nodules on the buttocks and thighs," later diagnosed as noninfectious suppurative panniculitis. 26 Broadly, injections are not without consequence; some cutaneous injections have been associated with the development of systemic diseases such as sarcoidosis and multiple sclerosis.…”

An Update on Facial Skin Rejuvenation Effectiveness of Mesotherapy EBM V

“…Thirty-one papers reported a wide range of side effects mostly about urticarial and lichenoid reactions to the injected medications and localized events, such as edema, erythema, ecchymosis, subcutaneous nodules, abscesses, and infections primarily mycobacterial, [32][33][34] but some relate more serious complications. 30,35,36,37,38 A review summarizing all the mesotherapy-related complications published so far and providing insight into their management was published recently by Plachouri et al 39 . The risk of infection remains among the main encountered complications of this procedure, mainly due to sterility issues.…”

“…Considered to be a relatively benign intervention, an observation worth mentioning is the large number of publications identified by this review about complications of mesotherapy for various indications. Thirty-one papers reported a wide range of side effects mostly about urticarial and lichenoid reactions to the injected medications and localized events, such as edema, erythema, ecchymosis, subcutaneous nodules, abscesses, and infections primarily mycobacterial, 32–34 but some relate more serious complications 30,35,36,37,38 . A review summarizing all the mesotherapy-related complications published so far and providing insight into their management was published recently by Plachouri et al 39 .…”

Resultados de la mesoterapia homeopática en el tratamiento de adiposidades localizadas

“…Paralelamente una búsqueda general arrojó otros 15 artículos. En cuanto a las posibles complicaciones de esta técnica se ha descrito en la literatura científica reacciones alérgicas, atrofia y lipodistrofia, hiperpigmentación postinflamatoria, nódulos e irregularidades, urticaria localizada, granuloma anular, paniculitis granulomatosa no infecciosa, reacciones vasovagales, lipotimias 1,4,5 , infecciones por mycobacterias atípicas 11,12,13,14 , edema transitorio, nauseas, vómito, hiperestesia de la piel, intoxicación al fármaco inyectado (cafeína) 16 y en algunos casos se ha descrito necrosis de la piel 1,4 .…”