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From Journal for Nurse Practitioners

Caffeine Intoxication and Addiction

Holly Pohler
Authors and Disclosures
Posted: 01/20/2010; Journal for Nurse Practitioners. 2010;6(1):49-52. © 2010

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• Abstract and Introduction

• Pharmacology and Pharmacokinetics
• Presentation
• Assessment
• Differential Diagnosis
• Management of Intoxication
• Caffeinism and Dependence
• Caffeine and Chronic Medical Conditions
• Education and Implications for the Nurse Practitioner

• References

Abstract and Introduction

Caffeine, one of the world's most popular psychoactive substances, is sought for its central nervous
system stimulant effects. If coffee, tea, and soda alone do not provide the desired stimulation, some
consumers are turning to the newest fad in the caffeine market, energy drinks. These beverages are
loaded with caffeine and sugar, infused with herbal additives, and marketed particularly to youth.
Caffeine produces dose-dependent symptoms, and intoxication may develop with overconsumption.
Caffeine is also recognized for its addictive properties, and discontinuation results in a withdrawal
syndrome. Nurse practitioners are encouraged to consider caffeine intoxication, addiction, and
withdrawal syndrome in the differential when patients complain of characteristic symptoms. Ongoing
nutritional assessment and education on moderation are key to reducing the overuse of caffeinated
energy drinks.

If you have relied on an afternoon double-shot caramel macchiato or a 64-ounce Mountain Dew
guzzler to get you through the day, you are not alone. People have been getting their caffeine buzz for
decades. Liquid Cocaine, Rock Star, and Red Bull are examples of the newest trend for those not
satisfied with soda and coffee alone. Containing caffeine levels significantly higher than the current
Food and Drug Administration (FDA) caffeine restriction, these popular beverages effectively bypass
the FDA caffeine restriction of 72 mg per 12 fluid ounces by virtue of the argument that they fall within
the 1994 Dietary Supplement Health and Education Act (Figure 1).[1] Most contain the added
ingredients high fructose corn syrup, sucrose, and herbal additives such as taurine, L-carnitine,
ginseng, and milk thistle, offering the illusion of a healthy alternative for a quick-energy high.
Figure 1.

Popular energy drinks and their caffeine content.[5–11]

(Enlarge Image)

Energy drinks pose a unique challenge to health care providers and the community at large. More than
500 new energy drinks have been launched this year and this 3.4 billion dollar a year industry
continues to grow.[2] Advertisements appeal to youth and are made attractive by claims of increased
performance, attention, endurance, and weight loss. Products are printed with the logos, "zero crash,"
"sustained energy," and "party like a rock star." Manufacturers of the energy drink Cocaine went so far
as to print the word cocaine on the can in such a manner that it resembles a line of illicit powdered

Post-Intoxication Vaccination for

Protection of Neurons against the
Toxicity of Nerve Agents
1. Hadas Schori*,
2. Eyal Robenshtok†,
3. Michal Schwartz*, 1 and
4. Ariel Hourvitz‡
+ Author Affiliations
1. *
Department of Neurobiology, The Weizmann
Institute of Science, 76100 Rehovot, Israel; †Department of
Internal Medicine E, Rabin Medical Center, Beilinson
Campus, Petah-Tikva 49100, Israel; and ‡Israel Defense
Force, Medical Corps, Chaim Sheba Medical Center, Tel
Hashomer 52621 Israel
1. 1
To whom correspondence should be addressed at
Department of Neurobiology, The Weizmann Institute of Science,
76100 Rehovot, Israel. Fax: 972 8 9346018. E-mail:

• Received March 24, 2005.

• Accepted June 7, 2005.

Next Section
Nerve agents are highly toxic organophosphates (OPs) that can cause
severe damage to the central and peripheral nervous systems. The
central nervous system insult results in seizures and neuronal death.
The glutamatergic system apparently contributes to the
neuropathology. Using a model of OP intoxication causing death of
retinal ganglion cells in the mouse eye, we show here that intoxication
is exacerbated if the mice are devoid of mature T cells. The retinal
neurons could be protected from these effects by vaccination, 7 days
before or immediately after intoxication, with the copolymer glatiramer
acetate (Cop-1), recently found to limit the usual consequences of an
acute glutamate insult to the eye. These findings underlie a new
therapeutic approach to protection against OP intoxication, based on
the rationale that boosting of the adaptive immunity recruited at the
site of intoxication helps the local cellular machinery such as resident
microglia to withstand the neurotoxic effects.

Research Article

Bacteriological Quality of Ready-to-Eat Foods Sold on

and Around University of Ghana Campus
D. Yeboah-Manu, G. Kpeli, M. Akyeh and L. Bimi

The aim of this study was to determine the Services
microbial quality of ready-to-eat foods being sold
in the open (street foods) and those from E-mail This Article
restaurants on the university of Ghana campus. A Related Articles in ASCI
total of 27 foods were sampled from the 5 sites.
Four microbiological parameters, namely Aerobic Similar Articles in this
Colony Count (ACC), total Enterobactereacea Journal
(EC), presence of Escherichia coli and other
Enterobacteriaceae and the presence of Search in Google Scholar
Salmonella sp. and Shigella sp. were used. Forty
Cited in (ASCI)
eight percent (13/27) of the foods sold had ACC
values within acceptable limits, that is <104 cfu g-1 Cited in (CrossRef)
whiles 52% (14/27) had ACC values above
acceptable limits and therefore, unsatisfactory for Report Citation
consumption, 59.3% had EC values within the
acceptable limits whiles 40.7% had EC above the
limit. Nine different bacterial species were isolated
from the foods sampled. These were E. coli,
Klebsiella pneumoniae, Streptococcus sp.,
Enterobacter cloacae, Bacillus sp., Pseudomonas
aeruginosa, Staphylococcus aureus, Proteus sp.,
Streptococcus agalactiae and Enterococcus
faecalis. On comparing the microbial qualities
from the two sectors we found no difference in
their microbiological qualities using student's t-
test analysis (t-test< t-value: 0.397<2.06). The
level of microbial contamination in some food
samples both the open market and restaurants
were above the acceptable limits. Therefore,
present findings call for a more stringent
supervision by the public health department of the
university to protect the university community
from future occurrence of food poisoning.

Rhizonin, the First Mycotoxin Isolated from the Zygomycota, Is

Not a Fungal Metabolite but Is Produced by Bacterial
Laila P. Partida-Martinez,1 Carina Flores de Looß,1 Keishi Ishida,1 Mie Ishida,1
Martin Roth,1 Katrin Buder,2 and Christian Hertweck1,3*
Leibniz Institute for Natural Product Research and Infection Biology (HKI), Jena,1 Leibniz
Institute for Age Research, (FLI), Jena,2 Friedrich Schiller University, Jena, Germany3

Received 27 July 2006/ Accepted 13 November 2006

Materials and
Results and

Rhizonin is a hepatotoxic cyclopeptide isolated from cultures of a fungal Rhizopus

microsporus strain that grew on moldy ground nuts in Mozambique. Reinvestigation of
this fungal strain by a series of experiments unequivocally revealed that this "first
mycotoxin from lower fungi" is actually not produced by the fungus. PCR experiments and
phylogenetic studies based on 16S rRNA gene sequences revealed that the fungus is
associated with bacteria belonging to the genus Burkholderia. By transmission electron
microscopy, the bacteria were localized within the fungal cytosol. Toxin production and
the presence of the endosymbionts were correlated by curing the fungus with an
antibiotic, yielding a nonproducing, symbiont-free phenotype. The final evidence for a
bacterial biogenesis of the toxin was obtained by the successful fermentation of the
endosymbiotic bacteria in pure culture and isolation of rhizonin A from the broth. This
finding is of particular interest since Rhizopus microsporus and related Rhizopus species
are frequently used in food preparations such as tempeh and sufu.

Bacteriocins: modes of action and potentials in food preservation and control of food poisoning.
T Abee, L Krockel, C Hill
International Journal of Food Microbiology 1995; 28(2):169-185
ICID: 657526
Article type: Original article
IC™ Value: 10.00

Lactic acid bacteria (LAB) play an essential role in the majority of food fermentations, and a wide variety of strains are routinely
employed as starter cultures in the manufacture of dairy, meat, vegetable and bakery products. One of the most important
contributions of these microorganisms is the extended shelf life of the fermented product by comparison to that of the raw
substrate. Growth of spoilage and pathogenic bacteria in these foods is inhibited due to competition for nutrients and the
presence of starter-derived inhibitors such as lactic acid, hydrogen peroxide and bacteriocins (Ray and Daeschel, 1992).
Bacteriocins, are a heterogenous group of anti-bacterial proteins that vary in spectrum of activity, mode of action, molecular
weight, genetic origin and biochemical properties. Currently, artificial chemical preservatives are employed to limit the number of
microorganisms capable of growing within foods, but increasing consumer awareness of potential health risks associated with
some of these substances has led researchers to examine the possibility of using bacteriocins produced by LAB as
biopreservatives. The major classes of bacteriocins produced by LAB include: (I) lantibiotics, (II) small heat stable peptides, (III)
large heat labile proteins, and (IV) complex proteins whose activity requires the association of carbohydrate or lipid moieties
(Klaenhammer, 1993). Significantly however, the inhibitory activity of these substances is confined to Gram-positive bacteria and
inhibition of Gram-negatives by these bacteriocins has not been demonstrated, an observation which can be explained by a
detailed analysis and comparison of the composition of Gram-positive and Gram-negative bacterial cell walls (Fig. 1). In both
types the cytoplasmic membrane which forms the border between the cytoplasm and the external environment, is surrounded by
a layer of peptidoglycan which is significantly thinner in Gram-negative bacteria than in Gram-positive bacteria. Gram-negative
bacteria possess an additional layer, the so-called outer membrane which is composed of phospholipids, proteins and
lipopolysaccharides (LPS), and this membrane is impermeable to most molecules. Nevertheless, the presence of porins in this
layer will allow the free diffusion of molecules with a molecular mass below 600 Da. The smallest bacteriocins produced by lactic
acid bacteria are approximately 3 kDa and are thus too large to reach their target, the cytoplasmic membrane (Klaenhammer,
1993; Stiles and Hastings, 1991). However, Stevens et al. (1991) and Ray (1993) have demonstrated that Salmonella species
and other Gram-negative bacteria become sensitive to nisin after exposure to treatments that change the permeability barrier
properties of the outer membrane (see below). This review will focus on the mode of action of lantibiotics (class I) and class II
LAB bacteriocins and their potentials in food preservation and control of food poisoning.