Pediatric Corner: Young patient has chest pain? Suspect caffeine
Young patient has chest pain? Suspect caffeine
Massive overdoses can be life-threatening
If a patient complains of heart palpitation or chest pain, you might not immediately suspect caffeine abuse, but this could be a growing problem among young people, according to a recently published study. Researchers looked retrospectively at 265 caffeine abuse cases called into a regional poison control center over a three-year period, and they found that 12% ended up in an area ED.1
"Young people taking caffeine either to stay awake or for a feeling of euphoria may actually end up in the emergency department more often than we think," says Danielle McCarthy, MD, the study's lead author and an emergency medicine resident at Northwestern University's Feinberg School of Medicine in Chicago. Young people being hospitalized for chest pains and heart palpitations are rarely asked if they've taken caffeine supplements because everyone perceives them to be safe, McCarthy adds.
Caffeine alone was abused in 186 of the cases and abused with other pharmaceutical products in 81 cases. The average age of those who had abused caffeine was 21.
"The patients called the poison center with a wide variety of complaints," says McCarthy. "Our study found that 31 patients were hospitalized and 20 of them required admission to the intensive care unit." Symptoms of caffeine abuse can include insomnia, palpitations, tremors, sweating, nausea, vomiting, diarrhea, chest pains, and neurologic symptoms, says McCarthy.
Patients abusing caffeine may present with dilated pupils, fast breathing, tremors, anxiety, and tachycardia, says Daniel E. Brooks, MD, chief of the division of medical toxicology in the Department of Emergency Medicine at University of Pittsburgh (PA) Medical Center. Nursing interventions include giving sedation, benzodiazepine, and intravenous fluids and ruling out other ingestions, he says.
ED nurses at University of Pittsburgh Medical Center see several caffeine abuse cases each month, reports Michele Kuszajewski, RN, MSN, CEN, clinical nurse specialist. If the patient presents with chest pain, the triage nurse asks these questions:
- Where exactly is the chest pain located?
- Does it go anywhere or stay in the same place?
- What does the pain feel like? Is it sharp, dull, pressure?
- What is the intensity of the pain?
- What is the duration of the pain — minutes, seconds, hours, or days?
- Does anything precipitate or relieve it? What makes it worse, what makes it better?
"These questions help us differentiate between chest related to cardiac disease versus other causes," says Kuszajewski.
Patients abusing caffeine have come to the ED with palpitations, tremors, and anxiety, says Kuszajewski. "The triage nurse may even see signs of paranoia in this patient," she says.
Although massive overdoses of caffeine can be life-threatening, overdosing usually results in vomiting that limits the amount absorbed, says Brooks. "Patients can also get seizures or hyperthermia if they are able to keep enough of it down, but there are usually mostly gastrointestinal effects," he says.
When you ask patients about drug use, including over-the-counter drugs, at triage, do so objectively and nonjudgmentally, advises Brooks. "Don't use words like abuse or overdose," he says. "First find out what is in their system and worry about why it's there later."
Simply ask the patient, "Have you been using any medications in the last day or so?" recommends Brooks. "It's a less confrontational way of getting the information," he says.
Reference
- McCarthy D. Hospitalization for caffeine abuse is associated with concomitant abuse of other pharmaceutical products. Summarized in a poster presented Oct. 15, 2006, at the 37th annual American College of Emergency Medicine Scientific Assembly.
Sources
For more information on pediatric soccer injuries in the ED, contact:
- Lisa Kluchurosky, Program Manager, Columbus Children's Hospital, Sports Medicine & Orthopedics, 584 County Line Road W., Westerville, OH 43082. Telephone: (614) 355-6000. E-mail: [email protected].
- Joyce Ordun, MS, CRNP, Nurse Practitioner, Pediatric Emergency Department, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205. E-mail: [email protected].
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