Caffeine Overdose Resulting in Seizure-like Activity and Rhabdomyolysis in a Child: A Case Report

Abstract

Background: Caffeine is a commonly used medication throughout pediatrics for its medicinal effects and recreation. While multiple reports have shown concern for overdoses in adolescents and adults, there is little reported on caffeine's effects on younger children.

Case report: We present the case of a 4-year-old female with developmental delay with associated seizures, who presented with unexplained tachycardia, and concern for increased seizure activity. After EEG showed no evidence of epileptiform changes, further investigation showed rhabdomyolysis, hypokalemia, tachycardia and ultimately elevated caffeine levels. This resulted in a diagnosis of factitious disorder by proxy.

Why should an emergency physician be aware of this: This is a rare case of caffeine overdose in a child resulting in rhabdomyolysis. While other stimulants are commonly considered in patients with such symptoms, and are included in standard drug screens, caffeine should also be evaluated as a cause of unexplained hyperactive behaviors, particularly in the non-verbal patient.

Keywords: caffeine; factitious disorder imposed on another; overdose; rhabdomyolysis.