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Massive Catecholamine Release From Caffeine Poisoning

Neal L. Benowitz, MD; John Osterloh, MD; Nora Goldschlager, MD; George Kaysen, MD; Susan Pond, MD; Sarah Forhan, MD
JAMA. 1982;248(9):1097-1098. doi:10.1001/jama.1982.03330090067033.
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CAFFEINE is widely consumed both in beverages such as coffee, tea, or cola soft drinks and in over-the-counter anorectic, stimulant, diuretic, and analgesic drugs. The sympathomimetic effects of caffeine are well known and are believed to result from inhibition of phosphodiesterase, an enzyme that degrades the β-adrenergic messenger, cyclic adenosine monophosphate. Recently, it was shown that caffeine in doses that might be consumed in beverages increases plasma catecholamine concentrations.1 We have observed a patient who took a suicidal overdose of caffeine and had a hyperadrenergic syndrome associated with markedly elevated circulating catecholamine concentrations.

Report of a Case  A 30-year-old woman was found on the floor of her room, acting bizarrely. She had a history of bipolar affective illness with hypomanic behavior and hallucinations. For several days, she had been obsessed with the idea that her body was ridden with cancer, which led to her ingestion of four bottles of


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