A case of heat stroke in abuse of energy drinks
A 20 year-old man was brought to the emergency room of our hospital because he was found at home unconscious, high fever (body temperature 40°C) and tonic seizure. The patient had no history of head trauma, fever or infection disease, nevertheless illicit drugs and or alcohol abuse. His friends reported: sleep-deficiency in the last day, and abuse of caffeinated energy drinks (about 8 cans= 2 liters). The patient spent the day in the pool, in a very hot summer day.
At admission, the patient was in a coma state, GCS 6 (E1, V1, M4). Pupils were wide, symmetric, with good reaction to light. No meningeal signs were found. Blood pressure was 140/80 mmHg, heart rate 110 bpm in sinus rhythm, respiratory rate 20 pm and tympanic temperature 40.3°C. Oxygen saturation was 98%, chest examination was clear. ECG showed sinus tachycardia. About 10 minutes after admission, the patient convulsed in a tonic-clonic manner with hyperextension of the right arm and leg. This condition was resolved by the administration of midazolam 5 mg iv.
The laboratory exams revealed leukocytosis (24,480/µL) with neutrophils 80%, normoglicaemia, normal electrolytes, serum creatinine 1.5 mg/dL, ALT 151 UI/L, AST 72 UI/L, CPK 609 UI/L, PCR 0,15 mg/dL, Procalcitonin 26,37 ng/mL. Arterial blood gas analysis with a FiO2 24% revealed pH 7.33, PaO2 193 mmHg, PaCO2 27 mmHg, HCO3- 20,.3 mmol/L and lactate 1.0 mmol/L. Urine screening for presence of cocaine, opioids, benzodiazepines, amphetamine, tetrahydrocannabinol were negative. Alcoholaemia was negative. The head CT was normal and the analysis of the cerebrospinal fluid revealed no proteinorrachia, no glycorrhachia, white blood cells absent.
Toxicity of energy drinks depends primary on caffeine concentration and time of assumption but adverse effects can be related also to environment exposure, assumption in association with alcohol or illicit substances, dehydration and sleep deprivation.
In this case we hypothesize that caffeinated energy drink linked diuresis, along with prolonged hot environment exposure, predisposed to dehydration and heat stroke with a worsening of the neurologic adverse effects of caffeine intoxication alone.
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