We have recently observed two serious toxicities secondary to ingestion of a caffeine-containing street drug preparation unfamiliar to most emergency physicians in the Louisville, Kentucky area. Due to the potentially grave consequences of this intoxication, we would like to alert other emergency physicians who may encounter this preparation in cases of unknown substance ingestion.
Case Number One. A 22-year-old man presented to the University Hospital ED approximately one hour after ingesting 15 to 20 '~RJ-8" capsules to get "high." He stated that one-half hour after ingestion of the product he experienced abdominal cramping immediately followed by vomiting. On presentation, the pulse was 150; respiratory rate, 20/min; and BP, 90/60 mm Hg. The patient was noted to be extremely anx-i0us and complained repeatedly of abdominal pain. Activated charcoal slurry and intravenous fluids were administered. The patient continued to retch for the ensuing 12 hours, but did not convulse. Toxicology screening of serum obtained on presentation was performed by coupled gas chromatography-mass spectroscopy (GC-MS). A large amount of caffeine was detected in the serum. Quantification, carried out by high pressure liquid chromatography (HPLC), revealed 74.6 txg/ml caffeine in the serum. No other drug substances were detected. Subsequent caffeine serum levels obtained over the next 24 hours demon-10:10 (October) 1981
Ann Emerg Med