Toxins, Toxicology

Toxic YouTube Challenges

Since its inception in 2005, YouTube has served as a platform for individuals to create and share video content online. Amid innocent videos of cats playing piano, however, a startling trend has emerged. In recent years, posters — often adolescents — have performed a stunt and then dared their friends to do the same. Some, like the ALS Ice Bucket Challenge, have been used to raise money and awareness for important causes. But more often they have devolved into viral dares ranging from silly to outright dangerous. The following are a few particularly toxic dares with consequences that emergency physicians need to know.

Tide Pod Challenge
Concentrated laundry pods provide convenience to consumers, but the flashy, candy-like appearance of many of these products has arguably led to accidental ingestions and fatalities in pediatric and demented elderly populations. For reasons unbeknownst to most high-functioning adults, the Tide Pod challenge has emerged in the past year. Posters intentionally place laundry pods in their mouth and attempt to hold it in place as drooling, foaming, and vomiting eventually ensue. (For more on the toxicological implications, please see the accompanying article.) Tide recently released a PSA in which New England Patriots tight end Rob Gronkowski warns against ingesting Tide pods. As with many things in life, if Gronk thinks something is a bad idea, it probably is.

Cinnamon Challenge
The Cinnamon Challenge involves participants trying (often unsuccessfully) to ingest a tablespoon of ground cinnamon. The irritating, fine particulate substance commonly leads to coughing, choking, and vomiting, making this dare a high aspiration risk. While human data is limited, in rat models aspiration of cinnamon leads to inflammatory changes and ultimately fibrotic changes in the lungs.1 Most exposures are mild and only require oral hydration and observation, but underlying asthma or cinnamon allergy are risk factors that could lead to dire consequences for this easily avoidable exposure.2

Ghost/Hot Pepper Challenge
The Ghost/Hot Pepper Challenge involves individuals eating one or multiple peppers with a high capsaicinoid content, such as the Ghost Pepper, Carolina Reaper, or Trinidad Scorpion. These peppers have Scoville Heat Units (SHU) in the millions, making them more than a thousand times more potent than your standard jalapeno. While the predominant result is schadenfreude, a few cases have resulted in serious mortality, including a report of one individual developing Boerhaave syndrome and subsequent pneumothorax.3

Soy Sauce Challenge
While not as viral as many of these challenges, high volume soy sauce ingestion have led to at least one interesting case presentation. On YouTube, this challenge involves posters taking shots of soy sauce and then attempting to hold back the sometimes-inevitable emesis. In 2013, a Virginia student was brought to the ED following ingestion of a quart-sized bottle of soy sauce and subsequent seizure.4 This patient had the highest recorded corrected sodium of 196 mmol/L with survival to discharge. While the outcome was ultimately positive, he required high-level ICU care and heroic measures because of this ingestion.

YouTube and social media sites like Facebook are now taking steps to stem the tide of increasingly dangerous challenges.5 By watching and sharing such videos, individuals are culpable in the injury of the vulnerable and susceptible adolescent population.

In the case any accidental or purposeful ingestion or exposure, please call the poison center hotline at 1-800-222-1222 to report any cases encountered in the emergency department.

References
1. Tátrai E, Adamis Z, Ungváry G. The pulmonary toxicity of cinnamon dust in rats. Indian J Med Res. 1995;102:287-292.
2. Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and Aspirating Dry Cinnamon by Children and Adolescents: The "Cinnamon Challenge". Pediatrics. 2013;131(5):833-835.
3. Arens A, Ben-Youssef L, Hayashi S, Smollin C. Esophageal Rupture After Ghost Pepper IngestionJ Emerg Med. 2016;51(6):e141-e143.
4. Carlberg DJ, Borek HA, Syverud SA, Holstege CP. Survival of Acute Hypernatremia Due to Massive Soy Sauce IngestionJ Emerg Med. 2013;45(2):228-231.
5. Lumb D. Facebook and YouTube are removing 'Tide Pod Challenge' videos. Engadget. Published January 18, 2018. Accessed January 23, 2018.

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