Dangerous viral challenges you need to know about

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Since the advent of adolescence and YouTube, there have been viral challenges. Since the early 2000s, starting with the saltine challenge (eating 6 saltines in 60 seconds without drinking water), kids continue to try out all kinds of challenges online. Some of these are simply funny, like the water condom challenge (what happens when you drop a condom full of water on someone’s head—yes. It breaks) and some are outright dangerous, like the Tide Pod challenge.

Eating challenges

Consuming tide pods
This is probably the most dangerous of the eating challenges. It appears that when the Tide Pods first came out, there was a joke going around that they looked so good, you wanted to eat them. Unfortunately, this turned out to be a somewhat prescient article, because young children DID start eating them, with very bad outcomes.
In an attempt to deter children from eating the pods, a very bitter substance (called Bitrex) was placed on the surface. If you put one in your mouth, the sudden bitterness you taste may cause you to inhale sharply, potentially lodging the pod in your wind pipe, blocking your ability to breathe and causing you to suffocate.
If you manage to swallow the pod, the concentrated detergent causes a chemical burn on contact, with your lips, and mouth, if you bite the pod first, as well as the esophagus and stomach. This triggers inflammation, your body’s way of trying to repair the damage, causing swelling in the areas that are burned. The detergent and dissolvable pod can also be difficult to swallow because it becomes quite gelatinous, allowing for an increased duration of contact with the tissues enroute down to the stomach, causing more significant burns. If there is a significant burn in the back of the throat, this may make it harder and harder to breathe as the area becomes increasingly swollen from inflammation. If some of the detergent sticks to the back of your throat, you may breathe some of it into your lungs, causing direct lung damage.
People who have ingested Tide Pods vomit repeatedly, can have wheezing and severe difficulty breathing, and some become very sleepy. This can result in needing to be on a ventilator due to inability to adequately breathe from excessive fluid in the lungs from lung damage (pulmonary edema), extreme airway swelling, or stopping of breathing. You can die from eating Tide Pods. You can suffer severe body damage from eating Tide Pods. Do NOT eat Tide Pods, or other detergent pods.

Swallow a tbsp of cinnamon in under 60 seconds without drinking anything
Cinnamon is a caustic powder that does not degrade or dissolve in the lungs. Trying to eat a large amount at once causes coating of the mouth and throat, not allowing for enough saliva production to moisten the powder. Some of the powder can be easily inhaled (aka aspirated) into the lungs where it causes an inflammatory reaction. This can result in an asthma attack for those with a history of asthma. It can also cause pneumonia or lung damage. In mice, cinnamon dust in the lungs caused fibrotic changes of the lungs (aka scarring) which causes lung stiffening. Needless to say, there have been no studies like this done in humans.
A similar challenge called the flour challenge involves someone swallowing a spoonful of flour without drinking water. The same concerns as the cinnamon challenge apply here.

The ghost pepper challenge — chew and swallow an entire ghost pepper without vomiting or crying
The chemical that makes hot peppers hot, capsaicin, activates pain receptors (TRPV1), which are normally activated in the presence of heat. This makes it feel like your mouth is on fire, which stimulates mucous production in your stomach, saliva in your mouth and a runny nose, because your body thinks there is a foreign substance that needs to be gotten rid of. This can really upset your stomach and contractions of your intestines due to inflammation, causing abdominal pain, as well as vomiting. If you have some pepper in your mouth and you inhale sharply, you could aspirate it, causing inflammation and lung damage. This could lead to pneumonia, lung scarring and shortness of breath. However, it takes an awful lot of ghost peppers to kill you (estimated to be 3 pounds of powdered ghost peppers in one sitting), so the effects are distressing, but should not cause permanent damage.

Drink an entire gallon of milk in an hour without vomiting
Most people who try to drink a gallon of anything quickly will feel sick, often vomiting. Your stomach was not designed to handle that much fluid at once and usually is limited to about ½ a gallon at a time. More than that causes stretching of the stomach wall, a stomach ache and the urge to vomit. The calcium in a gallon of the milk (equivalent to about 25 Tums antacid tablets) can throw off the acid balance in the stomach, causing stomach upset and vomiting. You shouldn’t have any long-term effects from drinking a gallon of milk quickly, unless you inhale the milk into your lungs as you are vomiting it up. Then you’re at risk for developing aspiration pneumonia.
The eat 2 bananas then drink a can of Sprite without vomiting challenge usually results in vomiting for the same reason.

Mentos and Coke challenge
The idea here is to put several Mentos candies in your mouth then trying to drink a Coke without spilling. Because the surface of the Mentos has small pits in it, each serving as a site of enucleation (formation of a bubble), your mouth will quickly fill with fizzed up soda, causing it to spew out of your mouth. Again, the risk here is aspiration of the soda or Mentos or both, potentially causing choking, asthma exacerbations or pneumonia.

Eat 6 saltines in 60 seconds, no water allowed
This is the challenge that we think started the viral challenge movement.
Saltines are very dry, overwhelming the amount of saliva in your mouth after about 2 crackers. This means that the rest of the saltines remain a dry dust in your mouth, ripe for inhaling into your lungs. This causes reflexive a coughing fit, complete with forceful inhalations, causing more aspirated food. Anything aspirated can lead to lung inflammation, asthma exacerbations and pneumonia.

Chubby Bunny – who can say “chubby bunny” with the most number of marshmallows in their mouth, no gagging, swallowing or chewing is allowed. Coughing, gagging or spitting puts you out of the game.
There have been at least 2 deaths from the Chubby Bunny challenge, both from choking on the marshmallows. Marshmallows stuffed in your mouth while trying to speak risks you inhaling the marshmallow into your windpipe. The marshmallow lodges in your windpipe, choking you so that you cannot breathe, so you suffocate to death. The marshmallow surface can get sticky when it gets wet and the soft consistency both make it more difficult to remove it from the airway.
A similar challenge of eating 24 Peeps in 5 minutes present similar risks. Peeps are very gooey and the risk of trying to eat a food of this consistency quickly would be the risk of choking.

150 Warheads Challenge-eating in less than 10 minutes
The source of the extreme sour of Warheads candy is malic acid, which is more acidic than citric acid, which gives citrus fruits their sour taste. The Warheads candy’s surface has malic acid on it and the underlying candy has citric acid. The acidity of malic acid is low enough that it can cause tooth enamel damage. Putting 150 Warheads in your mouth in a short period of time means a large amount of malic acid and persistent very acidic pH in the mouth for a prolonged period of time. This can lead to irritation of the mucous membranes of the mouth as well as superficial acid burns.

Reverse Sushi Roll Challenge- eat a giant ball of wasabi, drink 1 bottle of soy sauce then eat a King Kong-sized sushi tower (about 3-4 rolls) all in one sitting
Wasabi contains isothyocyanates, which activate the TRPA1 receptor on nerve cells, sending a signal to the brain that you have eaten something noxious. This causes your nose to start running due to mucous production to try to wash away the wasabi irritant. If you suddenly inhale in response to this noxious feeling, this can cause aspiration of the wasabi into your lungs, resulting in pneumonia as well as exacerbation of underlying lung problems, like asthma. Most likely you will just be very uncomfortable with a very runny nose.
The recommended daily allowance (RDA) for sodium is 2300 mg/day which is in around 2.5 Tablespoons of soy sauce. This challenge expects you to chug 20oz of soy sauce, which contains around 18,000 mg of sodium. Lethal doses of sodium have been described as being between 0.75 – 3g/kg of body weight (52,200 mg- 21,000 mg in a 70 kg person), which this challenge puts an average sized adult well under. However, taking in a large amount of sodium quickly can cause a rise in blood sodium levels, which can cause shifts of fluid into your blood vessels. For people who have a history of heart failure, they can have an exacerbation of their heart failure. For most people, the salt load would cause severe thirst.

Other dangerous challenges

Fire challenge
The fire challenge is one of the most obviously dangerous challenges, but somehow this did not deter many folks from trying it. The challenge is to pour alcohol on your skin then light it on fire. You would think that anyone would know what happens next, but the problem with most of these challenges is that the people on the video are either laughing or amazed and there is no video or discussion of the consequences of the challenge.

Choking challenge
The choking challenge works by either you or someone else puts something around your neck or puts their hands around your neck, choking you until you feel like you’re going to pass out, but then releasing the pressure before you do. The reason people do this is to feel the euphoria just prior to passing out then the rush from the sudden surge of blood back into your brain after the pressure is released. Needless to say, if a person tries to do this on their own, the could accidentally pass out before they are able to remove the ligature from their neck, causing death by strangulation.

Duct tape challenge
A Washington teenager almost died as a result of the duct tape challenge in 2016. The challenge involves wrapping duct tape around someone’s body then seeing how quickly then can escape. Where this can go wrong is when the person falls and strikes their head the wrong way. They may be lucky and have a bump or cut on their head or they could suffer a concussion or even brain hemorrhage, which is what happened to the teenager in Washington.

Salt and ice challenge
This challenge consists of pouring salt on your body then putting ice on the salt. This causes a burning sensation. The challenge is to see how long you can withstand the pain. The addition of salt to ice causes a drop in the melting point of ice, keeping the ice solid at lower temperatures. This allows for a concentrated area of coldness to be applied to the area of skin longer, which can cause a full thickness burn after several minutes. This has sent kids to the hospital with serious injuries after having had the ice on their skin for 10-20 minutes.

The perfect storm of an immature brain, bravado, a desire to seek out new and exciting experiences, the tendency toward “one upmanship”, and exposure to larger, different and sometimes dangerous social circles, has lead to a seemingly never-ending parade of internet challenges. Staying up to date on the challenges out there and being aware of the risks and signs are important to keeping your child and yourself safe.

Do you have more questions or do you want to see me as a patient via your phone or computer? Reach out to me via social media (@mydoctorfriend on Twitter, Facebook, Google +, Instagram) or my website (www.my-doctor-friend.com). If you want to make an appointment to see me via telemedicine, go to http://www.rowedocs.com/irenetien.

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