Caffeinism

Last updated
Caffeinism
Other namesCaffeine overdose
Specialty Toxicology, psychiatry, neurology

Caffeinism is a state of intoxication caused by excessive consumption of caffeine. This intoxication covers a variety of unpleasant physical and mental symptoms associated with the consumption of excessive amounts of caffeine. [1]

Contents

Caffeine is considered one of the most widely consumed drugs around the world. Around 80% of the world population consumes caffeine in one form or another. [2] It is found in coffee, tea, caffeinated alcoholic drinks, cocoa, chocolate, soft drinks, especially cola, and is an important component of energy drinks and other dietary supplements. [1]

Caffeine is also an ingredient of several medications, many of them over-the-counter and prescription drugs. The consensus is to consider caffeine a drug with pharmacological effects acting throughout the body.

Signs and symptoms

Primary symptoms of caffeine intoxication Main symptoms of Caffeine overdose.svg
Primary symptoms of caffeine intoxication

In moderate doses, caffeine is used to reduce physical fatigue, to prevent drowsiness and sleep, and to maintain and restore mental alertness and wakefulness. However, at higher doses, these stimulatory effects can become excessive and lead to a wide range of unpleasant symptoms including a dysphoric physical and mental state that is labeled caffeinism and is also known colloquially as "coffee nerves" or "caffeine jitters." These symptoms including nervousness, irritability, restlessness, insomnia, headaches, and palpitations after caffeine use. [4]

Caffeinism usually occurs when consumption of caffeine reaches 1–1.5 grams (0.035–0.053 oz) per day. [5] For reference, a brewed 8oz (227ml) cup of coffee contains ~95 mg of caffeine (per USDA). [6]

According to the Diagnostic and Statistical Manual of Mental Disorders, caffeine overdose can result in a state of excessive stimulation of the central nervous system and the essential feature of Caffeine Intoxication is the recent consumption of caffeine. This diagnosis requires the presence of at least five signs or symptoms, from a list of 12, that develop during or shortly after caffeine use. [7] This syndrome regularly happens when a person ingested large amounts of caffeine from any source (e.g., more than 400–500 mg at a time).

The signs and symptoms are divided into one group that can appear after an intake of as little as 100 mg of caffeine (roughly the amount contained in a cup of brewed coffee) and another group of symptoms that appear at higher levels of intake (more than 1 g per day). Low-dose symptoms include

  1. restlessness,
  2. nervousness,
  3. excitement,
  4. insomnia,
  5. flushed face,
  6. diuresis (increased urination), and
  7. gastrointestinal disturbance.

Symptoms associated with high doses of caffeine include

  1. muscle twitching,
  2. rambling flow of thought and speech,
  3. tachycardia and cardiac arrhythmia,
  4. periods of inexhaustibility, and
  5. psychomotor agitation, [1]
  6. anorexia (loss of appetite),
  7. seizures,
  8. death.

The symptoms of caffeine intoxication are comparable to the symptoms of overdoses of other stimulants. [3] In cases of much larger overdoses, mania, depression, lapses in judgment, disorientation, disinhibition, delusions, weight loss, loss of appetite, hallucinations, or psychosis may occur. [8] [9]

Death can occur as a result of caffeine overdose. [10] [11] The LD50 of caffeine in humans is dependent on individual sensitivity, but is estimated to be 150–200 milligrams per kilogram of body mass (75–100 cups of coffee for a 70 kilogram adult). [12] A number of fatalities have been caused by overdoses of readily available powdered caffeine supplements, for which the estimated lethal amount is less than a tablespoon. [13] The lethal dose is lower in individuals whose ability to metabolize caffeine is impaired due to genetics or chronic liver disease. [14] A death was reported in a man with liver cirrhosis who overdosed on caffeinated mints. [15] [16] [17]

Treatment

Treatment of mild caffeine intoxication is directed toward symptom relief; severe intoxication may require peritoneal dialysis, hemodialysis, or hemofiltration. [3] Control of caffeine intake requires awareness of the caffeine content of caffeinated beverages, over-the-counter drugs, and other sources of caffeine in the diet. Such information is not easy to obtain. The content of brewed beverages such as coffee and tea varies greatly based on the method of preparation. [18]

There is no standard value for "a cup of coffee." The caffeine content of cola drinks and most energy drinks can be difficult to determine, because in many cases the labels do not indicate the dose per serving. Caffeine doses in these beverages range from 20 to 30 mg in some soft drinks, up to 350 mg or more in some energy drinks. Although some Internet web sites report caffeine content for beverages, official lists are not available and the number of brands continually grows. [1]

Attempting to abruptly discontinue all consumption of caffeine-containing products from the diet is not usually recommended. The person could suffer from severe symptoms of caffeine withdrawal including headaches, fatigue, and difficulty concentrating. It is recommended that the person reduces caffeine consumption gradually to avoid withdrawal as attempts to suddenly discontinue all caffeine consumption are frequently abandoned due to the severity of the withdrawal symptoms. [1] [18]

Epidemiology

Little is known about the prevalence of caffeinism in the general population. Although most people are familiar with the disorder, it probably remains underdiagnosed, because patients are rarely questioned about the use of caffeine. [2]

See also

Related Research Articles

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Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used as a eugeroic (wakefulness promoter) or as a mild cognitive enhancer to increase alertness and attentional performance. Caffeine acts by blocking binding of adenosine to the adenosine A1 receptor, which enhances release of the neurotransmitter acetylcholine. Caffeine has a three-dimensional structure similar to that of adenosine, which allows it to bind and block its receptors. Caffeine also increases cyclic AMP levels through nonselective inhibition of phosphodiesterase.

<span class="mw-page-title-main">Alcohol intoxication</span> Behavioural and physical changes due to the consumption of alcohol

Alcohol intoxication, also known in overdose as alcohol poisoning, commonly described as drunkenness or inebriation, is the behavior and physical effects caused by a recent consumption of alcohol. In addition to the toxicity of ethanol, the main psychoactive component of alcoholic beverages, other physiological symptoms may arise from the activity of acetaldehyde, a metabolite of alcohol. These effects may not arise until hours after ingestion and may contribute to the condition colloquially known as a hangover. The term intoxication is commonly used when large amount of alcohol is consumed along with physical symptoms and deleterious health effects.

<span class="mw-page-title-main">Stimulant</span> Drug that increases activity of central nervous system

Stimulants are a class of drugs that increase the activity of the brain and the spinal cord. They are used for various purposes, such as enhancing alertness, attention, motivation, cognition, mood, and physical performance. Some of the most common stimulants are caffeine, nicotine, amphetamines, cocaine, and modafinil.

<span class="mw-page-title-main">Energy drink</span> Beverage containing stimulants

An energy drink is a type of drink containing stimulant compounds, usually caffeine, which is marketed as providing mental and physical stimulation. They may or may not be carbonated and may also contain sugar, other sweeteners, or herbal extracts, among numerous other possible ingredients.

<span class="mw-page-title-main">Caffeinated drink</span> Type of drink

A caffeinated drink, or caffeinated beverage, is a drink that contains caffeine, a stimulant that is legal practically all over the world. Some are naturally caffeinated while others have caffeine added as an ingredient.

Although health benefits have been assumed throughout the history of using Camellia sinensis as a common beverage, there is no high-quality evidence that consuming tea confers significant benefits other than possibly increasing alertness, an effect caused by caffeine in the tea leaves. In clinical research conducted over the early 21st century, tea has been studied extensively for its potential to lower the risk of human diseases, but there is no good scientific evidence to indicate that consuming tea affects any disease or improves health.

<span class="mw-page-title-main">Caffeine dependence</span> Medical condition

Caffeine dependence is a condition characterized by a set of criteria including tolerance, withdrawal symptoms, persistent desire or unsuccessful efforts to control use, and continued use despite knowledge of adverse consequences attributed to caffeine. It can appear in physical dependence or psychological dependence, or both. Caffeine is one of the most common additives in many consumer products, including pills and beverages such as caffeinated alcoholic beverages, energy drinks, pain reliever medications, and colas. Caffeine is found naturally in plants such as coffee and tea and other plants. Studies have found that 89 percent of adults in the U.S. consume on average 200 mg of caffeine daily. One area of concern that has been presented is the relationship between pregnancy and caffeine consumption. Repeated caffeine doses of 100mg appeared to result in smaller size at birth in newborns. When looking at birth weight however, caffeine consumption did not appear to make an impact.

The health effects of coffee include various health benefits and health risks.

Caffeine-induced sleep disorder is a psychiatric disorder that results from overconsumption of the stimulant caffeine. Caffeine is one of the most widely consumed psychoactive drugs: almost 90% of Americans in a survey consume some type of caffeine each day. "When caffeine is consumed immediately before bedtime or .... throughout the day, sleep onset may be delayed, total sleep time reduced, normal stages of sleep altered, and the quality of sleep decreased." Caffeine reduces slow-wave sleep in the early part of the sleep cycle and can reduce rapid eye movement sleep later in the cycle. Caffeine increases episodes of wakefulness, and high doses in the late evening can increase sleep onset latency. In elderly people, there is an association between use of medication containing caffeine and difficulty in falling asleep.

<span class="mw-page-title-main">Effect of caffeine on memory</span>

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<span class="mw-page-title-main">Low caffeine coffee</span>

Low caffeine coffee is a term that is used by coffee producers to describe coffee that has not been subjected to a process of decaffeination, but is substantially lower in caffeine than average coffee. Samples of coffee vary widely in caffeine levels due to many factors, some well documented and some not fully understood, such as the action of soil, water levels and sunlight. Low caffeine coffees are typically created by assaying caffeine levels of different bean lots and selecting the best flavor profile from the lots that are naturally lowest in caffeine.

<span class="mw-page-title-main">Caffeinated alcoholic drink</span> Drink containing both alcohol and caffeine

A caffeinated alcoholic drink is a drink that contains both alcohol and a significant amount of caffeine. Caffeine, a stimulant, masks some of the depressant effects of alcohol. However, in 2010 and 2011, this type of drink faced criticism for posing health risks to its drinkers. In some places there is a ban on caffeinated alcoholic drinks.

<span class="mw-page-title-main">Ban on caffeinated alcoholic drinks in the United States</span> November 2010 drinks ban

The 17 November 2010 United States ban on caffeinated alcoholic drinks is a ban which prevents the marketing and distribution of any prepackaged caffeinated alcoholic drink.

<span class="mw-page-title-main">Alcohol (drug)</span> Active ingredient in fermented drinks

Alcohol, sometimes referred to by the chemical name ethanol, is a depressant drug found in fermented beverages such as beer, wine, and distilled spirit -- in particular, rectified spirit. Ethanol is colloquially refereed to as "alcohol" because it is the most prevalent alcohol in alcoholic beverages, but technically all alcoholic beverages contain several types of psychoactive alcohols, that are categorized as primary, secondary, or tertiary; Primary, and secondary alcohols, are oxidized to aldehydes, and ketones, respectively, while tertiary alcohols are generally resistant to oxidation; Ethanol is a primary alcohol that has unpleasant actions in the body, many of which are mediated by its toxic metabolite acetaldehyde. Less prevalent alcohols found in alcoholic beverages, are secondary, and tertiary alcohols. For example, the tertiary alcohol 2M2B which is up to 50 times more potent than ethanol and found in trace quantities in alcoholic beverages, has been synthesized and used as a designer drug. Alcoholic beverages are sometimes laced with toxic alcohols, such as methanol and isopropyl alcohol. A mild, brief exposure to isopropyl alcohol is unlikely to cause any serious harm, but many methanol poisoning incidents have occurred through history, since methanol is lethal even in small quantities, as little as 10–15 milliliters. Ethanol is used to treat methanol and ethylene glycol toxicity.

Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder.

<span class="mw-page-title-main">Lithium toxicity</span> Medical condition

Lithium toxicity, also known as lithium overdose, is the condition of having too much lithium. Symptoms may include a tremor, increased reflexes, trouble walking, kidney problems, and an altered level of consciousness. Some symptoms may last for a year after levels return to normal. Complications may include serotonin syndrome.

Stimulant use disorder is a type of substance use disorder where the use of stimulants caused clinically significant impairment or distress. It is defined in the DSM-5 as "the continued use of amphetamine-type substances, cocaine, or other stimulants leading to clinically significant impairment or distress, from mild to severe". These psychoactive drugs, known as stimulants, are among the most widely used drugs in the world today, although not all stimulants can induce addiction. As of 1993, Approximately 200 million Americans have used some type of stimulant in the past year alone.

<span class="mw-page-title-main">Caffeine-induced psychosis</span> Mental disorder

Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited.

References

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