Caffeine abuse may be missed in the ED.

ED managers should be aware of the tendency of young people to abuse caffeine and other nonprescription drugs. Experts say they end up in the ED more often than we think. Be sure to ask young patients with chest pain or heart palpitations whether they have taken any caffeine supplements. Be aware that most caffeine abusers also are abusing other pharmaceuticals such as dextramathorphan. Symptoms of caffeine abuse can include insomnia, tremors, sweating, nausea, vomiting, diarrhea, and neurological symptoms.