Multiple-dose activated charcoal is warranted. Alkalinization of the urine with sodium bicarbonate can be done to hasten urinary excretion, though this requires intense monitoring and is difficult to achieve safely. Peritoneal dialysis allows direct removal of salicylic acid from serum. Gastric ulceration or perforation is treated as needed. Theobromine inhibits phosphodiesterase, which results in increased cAMP and release of catecholamines.
Caffeine directly stimulates the myocardium and central nervous system.
It also causes a competitive antagonism of cellular adenosine receptors. Benzodiazepine receptors in the brain are competitively antagonized. A slight increase in blood pressure is seen. Bradycardia or more commonly tachycardia occurs, and myocardial dysrhythmias, especially ventricular premature beats, are possible. Central nervous system excitability, manifested as nervousness, excitement, tremors, seizures, and ultimately coma, are seen.