Worsening symptoms in patients may just be a sign of caffeine or nicotine withdrawal, doctors warn 

Worsening symptoms in intensive care patients may just be a sign of caffeine or nicotine withdrawal and not warrant any costly tests, doctors warn

  • Going cold turkey on coffee and cigarettes can leave people feeling more ill
  • Symptoms include nausea, headaches and can last for two weeks 
  • Doctors may send for scans or X-rays incase of a life-threatening illness  
  • A review found smokers are more agitate which can affect their treatment 

Caffeine and nicotine withdrawal is being mistaken among intensive care patients for more sinister conditions, researchers fear.

They said doctors may be wasting both time and money by sending patients who have gone cold turkey for extra tests if they are worsening.

Giving up nicotine and caffeine can cause the shakes and nausea – symptoms that can mimic life-threatening illnesses such as meningitis.

Every time patients are whisked off for unnecessary testing, they are at risk of harm, Bulgarian scientists have said.

Queen Giovanna University Hospital in Bulgaria researchers reviewed 12 studies of patients in intensive care, involving almost 500 adults.

Doctors are wasting time and money by sending patients who are having caffeine and nicotine withdrawal for tests, doctors have warned

Results showed that short term nicotine withdrawal substantially increases agitation in patients.

A total of 64 per cent of smokers who have been unable to get a nicotine hit are agitated compared to 32 per cent of non-smokers. 

This is a concern because treatment may become more difficult – the number of tracheal tube and intravenous line displacements caused by agitation in ICU patients were 14 per cent for smokers and three per cent in non-smokers.

Intravenous lines gives fluids or medications by being inserted through the skin and into the vein and a tracheal tube is to help ventilate the lungs.

To give patients nicotine substitution in the form of things such as gum or patches doesn’t appear to help.


Nicotine, the addictive substance in cigarettes, changes in the balance of chemical messengers in their brain when used over a long time.

When a person stops using nicotine quickly, they disrupt this chemical balance and experience physical and psychological side effects which are hard to manage when trying to quit smoking.

Smokers complain of headaches, sweating, tremors, increased hunger and difficult concentrating, for example. Their cravings may leave them feeling anxious and low in mood.  

Caffeine is not addictive, but people can become dependent on it. 

The stimulant increases the release of stress hormones and adrenaline which give you that energy boost. But the surge doesn’t last for long, which is why people will quickly reach for another cup.

They will then get into a cycle of needing caffeine to ‘wake them up’ from crashes. 

Cutting back can cause headaches, fatigue, irritability, anxiety and low concentration. 

Some nicotine addicts responded well with fewer headaches, but others developed delirium, including severe confusion and disorientation.

This can prolong hospital stays and is linked to an increased death rate in intensive care, according to the study.

Lead author Dr Maya Belitova said: ‘Nicotine and caffeine are some of the most commonly used and highly addictive substances in modern society.

‘But they are often overlooked as a potential source of significant withdrawal symptoms when abruptly discontinued in Intensive Care Units.

‘Symptoms resemble conditions such as meningitis, encephalitis, and intracranial haemorrhage.

‘This may confuse clinical diagnosis and result in unnecessary tests which can cause patient harm, cost a lot of money, and waste time.’

She added: ‘[Some] ICU patients may benefit from nicotine substitution or caffeine supplementation.

‘But with little evidence for their effectiveness, this should be left up to the judgement of treating physicians.’

She said future research should focus on how caffeine withdrawal leads to agitation and which treatment options are available.

Symptoms of sudden caffeine and nicotine withdrawal, including vomiting and delirium, can last up to two weeks.

Europe has the highest prevalence of tobacco smoking among adults at 28 per cent, according to the World Health Organization.

Half the population drink coffee, according to the researchers, but official figures are unclear.  

Read more at DailyMail.co.uk