Jump to content

Caffeine toxicity

This article's lead is ready for translation. Click for more information.
From WikiProjectMed
Caffeine toxicity
Other names: Caffeine overdose; caffeinism;[1] syndrome of coffee[2]
Torso of a young man with overlaid text of main side-effects of caffeine overdose.
Primary symptoms of caffeine intoxication[3]
SpecialtyToxicology
SymptomsFast heart rate, anxiety, trouble sleeping, nausea, headache[4]
ComplicationsSeizures, heart arrhythmias[5]
Usual onsetWithin 2hrs[6]
TypesAcute, chronic[7]
CausesCaffeine (accidental, on purpose)[8]
Diagnostic methodMay confirm by blood testing[8]
Differential diagnosisOther stimulants, theobromine toxicity[7][9]
TreatmentSupportive care, activated charcoal, gastric lavage[8]
DeathsRare[8]

Caffeine toxicity, also known as caffeinism, is toxicity due to excessive caffeine.[8][1] Symptoms may include a fast heart rate, anxiety, trouble sleeping, nausea, and headache.[4] Onset is generally within two hour of exposure.[8][6] More serious effects may include seizures, low potassium, and heart arrhythmias.[5][7]

It can occur unintentionally or on purpose.[8] Negative effects often begin after 300 to 1,200 mg of caffeine, while less than 400 mg is generally well tolerated by adults.[4][10] Caffeine is often in coffee, tea, chocolate, soft drinks, energy drinks, caffeinated alcoholic drinks, and dietary supplements including those used for weight loss and body building.[4][10][9] It is also present in certain medications, and potentially chewing gum and ice cream.[4] Risks of toxicity include those with liver disease or heart problems.[10] Certain labs may be able to test caffeine blood levels.[8]

Treatment for minor cases is supportive care.[8] In larger overdoses activated charcoal or gastric lavage may be useful early.[8] In significant toxicity intravenous fluids, esmolol, procainamide, or bicarbonate may be used.[8] Electrical cardioversion is not very useful; thought, norepinephrine or phenylephrine may be used to support the blood pressure.[8] Hemodialysis or lipid emulsion may also be beneficial.[8]

Caffeine globally is used in some form by around 80% of people.[11] However, severe toxicity resulting in death is rare with generally less than a couple a year in the United States.[8] Death usually requires grams of caffeine to be taken.[10] Medical descriptions of toxicity date back to the early 1900s.[2]

Signs and symptoms

In moderate doses, caffeine reduces physical fatigue, drowsiness and sleep, and restores mental alertness and wakefulness in the short term. However, at higher doses, these 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.[12]

Caffeinism usually occurs when consumption of caffeine reaches 1–1.5 grams (0.035–0.053 oz) per day.[13] For reference, a brewed 8oz (227ml) cup of coffee contains ~95 mg of caffeine (per USDA).[14]

Symptoms are divided into those that appear after an intake of as little as 100 mg of caffeine (roughly the amount contained in a cup of brewed coffee) and those at higher levels of intake (more than 1 g per day).

Low-dose symptoms includes:

Symptoms with high doses include:

The symptoms of caffeine intoxication are comparable to those 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.[16][17]

Death can occur as a result of caffeine overdose.[18][19] 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).[20] 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.[21] The lethal dose is lower in individuals whose ability to metabolize caffeine is impaired due to genetics or chronic liver disease.[22] A death was reported in a man with liver cirrhosis who overdosed on caffeinated mints.[23][24][25]

Cause

Control of caffeine intake requires awareness of the caffeine content of drinks, over-the-counter drugs, and other sources. 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.[26]

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 websites report caffeine content for beverages, official lists are not available and the number of brands continually grows.[15]

Amounts that potentially result in death are about 150 to 200 mg/kg.[9]

Diagnosis

Per the Diagnostic and Statistical Manual of Mental Disorders, caffeine overdose results in a state of excessive stimulation of the central nervous system and the essential feature of caffeine intoxication is the recent consumption of caffeine. The diagnosis requires the presence of at least five signs or symptoms, from a list of 12, that develop during or shortly after caffeine use.[27] 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).

Treatment

Treatment of mild caffeine intoxication is directed toward symptom relief; severe intoxication may require peritoneal dialysis, hemodialysis, or hemofiltration.[3]

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.[15][26]

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 many rarely question the use of caffeine.[11]

See also

References

  1. ↑ 1.0 1.1 New Zealand Medicines and Medical Devices Safety Authority editorial staff (August 1999). "Too Much Caffeine". New Zealand Ministry of Health. Archived from the original on 2025-03-17. Caffeine overdose... has been termed "caffeinism," which is caused by toxic levels of caffeine.
  2. ↑ 2.0 2.1 Iancu, Iulian (25 October 2006). Caffeinism: History, Clinical Features, Diagnosis, and Treatment. CRC Press. Retrieved 3 October 2025.
  3. ↑ 3.0 3.1 3.2 "Caffeine (Systemic)". MedlinePlus. 25 May 2000. Archived from the original on 23 February 2007. Retrieved 3 August 2009.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Commissioner, Office of the (29 August 2024). "Spilling the Beans: How Much Caffeine is Too Much?". FDA. Archived from the original on 4 January 2024. Retrieved 17 September 2025.
  5. ↑ 5.0 5.1 De Sanctis, V; Soliman, N; Soliman, AT; Elsedfy, H; Di Maio, S; El Kholy, M; Fiscina, B (23 August 2017). "Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: a significant public health hazard". Acta bio-medica : Atenei Parmensis. 88 (2): 222–231. doi:10.23750/abm.v88i2.6664. PMID 28845841.
  6. ↑ 6.0 6.1 "Caffeine". mobile.fpnotebook.com. Archived from the original on 12 February 2025. Retrieved 4 October 2025.
  7. ↑ 7.0 7.1 7.2 Willson, C (2018). "The clinical toxicology of caffeine: A review and case study". Toxicology reports. 5: 1140–1152. doi:10.1016/j.toxrep.2018.11.002. PMC 6247400. PMID 30505695.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 Murray, A; Traylor, J (January 2025). "Caffeine Toxicity". StatPearls. PMID 30422505.
  9. ↑ 9.0 9.1 9.2 Goldfrank's toxicologic emergencies (Eleventh ed.). New York: McGraw-Hill Education. 2019. p. 985. ISBN 978-1259859618. Retrieved 4 October 2025.
  10. ↑ 10.0 10.1 10.2 10.3 Musgrave, IF; Farrington, RL; Hoban, C; Byard, RW (September 2016). "Caffeine toxicity in forensic practice: possible effects and under-appreciated sources". Forensic science, medicine, and pathology. 12 (3): 299–303. doi:10.1007/s12024-016-9786-9. PMID 27344159.
  11. ↑ 11.0 11.1 Iancu, I; Strous, RD (February 2006). "Caffeine intoxication: history, clinical features, diagnosis and treatment". Harefuah. 145 (2): 147–51, 163–4. PMID 16509422.
  12. ↑ Iancu I, Olmer A, Strous RD (2007). "Caffeinism: History, clinical features, diagnosis, and treatment". In Smith BD, Gupta U, Gupta BS (eds.). Caffeine and Activation Theory: Effects on Health and Behavior. CRC Press. pp. 331–344. ISBN 978-0-8493-7102-8. Retrieved 15 January 2014.
  13. ↑ Winston AP, Hardwick E, Jaberi N (2005). "Neuropsychiatric effects of caffeine". Advances in Psychiatric Treatment. 11 (6): 432–439. doi:10.1192/apt.11.6.432.
  14. ↑ "FoodData Central". ndb.nal.usda.gov. Archived from the original on April 3, 2019. Retrieved 2020-10-02.
  15. ↑ 15.0 15.1 15.2 Stolerman, Ian P. (2010). Encyclopedia of Psychopharmacology (Online-Ausg. ed.). Berlin, Heidelberg: Springer-Verlag Berlin Heidelberg. pp. 261–264. ISBN 978-3-540-68706-1.
  16. ↑ "Caffeine overdose". MedlinePlus. 4 April 2006. Archived from the original on 5 July 2016. Retrieved 3 August 2009.
  17. ↑ Verkhratsky A (January 2005). "Physiology and pathophysiology of the calcium store in the endoplasmic reticulum of neurons". Physiological Reviews. 85 (1): 201–79. doi:10.1152/physrev.00004.2004. PMID 15618481. S2CID 11820734.
  18. ↑ Holmgren P, Nordén-Pettersson L, Ahlner J (January 2004). "Caffeine fatalities – four case reports". Forensic Science International. 139 (1): 71–3. doi:10.1016/j.forsciint.2003.09.019. PMID 14687776.
  19. ↑ "FDA Consumer Advice on Powdered Pure Caffeine". FDA. Archived from the original on July 18, 2014. Retrieved 20 August 2014.
  20. ↑ Peters JM (1967). "Factors Affecting Caffeine Toxicity: A Review of the Literature". The Journal of Clinical Pharmacology and the Journal of New Drugs. 7 (3): 131–141. doi:10.1002/j.1552-4604.1967.tb00034.x. Archived from the original on 12 January 2012.
  21. ↑ Murray Carpenter (18 May 2015). "Caffeine powder poses deadly risks". New York Times. Archived from the original on 25 January 2022. Retrieved 18 May 2015.
  22. ↑ Rodopoulos N, Wisén O, Norman A (May 1995). "Caffeine metabolism in patients with chronic liver disease". Scandinavian Journal of Clinical and Laboratory Investigation. 55 (3): 229–42. doi:10.3109/00365519509089618. PMID 7638557.
  23. ↑ Cheston P, Smith L (11 October 2013). "Man died after overdosing on caffeine mints". The Independent. Archived from the original on 12 October 2013. Retrieved 13 October 2013.
  24. ↑ Prynne M (11 October 2013). "Warning over caffeine sweets after father dies from overdose". The Telegraph. Archived from the original on 11 October 2013. Retrieved 13 October 2013.
  25. ↑ Fricker M (12 October 2013). "John Jackson: Family of dad who died from caffeine overdose after eating MINTS want them removed from sale". Daily Mirror. Archived from the original on 15 February 2022. Retrieved 13 October 2013.
  26. ↑ 26.0 26.1 Haenel, H. (1992). "J. E. James: Caffeine and Health. 432 Seiten. Academic Press, London, San Diego, New York u. a. Preis: 29,50 £; 59,95 $". Food/Nahrung. 36 (4): 431. doi:10.1002/food.19920360453.
  27. ↑ American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association. ISBN 978-0-89042-062-1.

External links

Classification

Retrieved from "https://mdwiki.org/w/index.php?title=Caffeine_toxicity&oldid=1480547"