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Abstract
A 53-year-old male with a past medical history of type I diabetes mellitus presented to our emergency department after being found obtunded at home following ingestion of a large amount of the caffeinated alcoholic beverage 4 Loko. The patient had profound hyperkalaemia, diabetic ketoacidosis and acute renal failure. He was admitted to the intensive care unit and was aggressively resuscitated with intravenous fluids. He was treated with insulin and sodium bicarbonate and had complete resolution of his acidosis and hyperkalaemia. Since their introduction, caffeinated alcoholic beverages have become increasingly popular, with expected sales of several billion dollars in 2011. The caffeine present in these beverages masks the depressant effect of alcohol and may thus lead to greater alcohol intake and make risk-taking behaviours more common. These beverages have not been studied in those with chronic medical conditions. As this case exemplifies, they may lead to excessive morbidity in those susceptible patients.