Serum caffeine concentration (if available) >100 mg/L (555 mmol/L) in acute exposure, >60 mg/L (333 mmol/L) in chronic exposure
Presence of seizures
Life-threatening dysrhythmias or shock
Caffeine concentration (if available) that is rising despite optimal treatment
Clinical deterioration despite optimal therapy
Progressively worsening moderate to severe symptoms and cannot tolerate MDAC
MDAC: multiple-dose activated charcoal.
References:
Hoffman RJ. Methylxanthines and selective β2-adrenergic agonists. In: Goldfrank's Toxicologic Emergencies, 11th ed, Nelson LS, Howland M, Lewin NA, et al (Eds), McGraw Hill 2019. p.985.
Ghannoum M, Wiegand TJ, Liu KD, et al. Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila) 2015; 53:215.
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