Recommended Citation: Mittal V and Aks S. The Toxic Shelf - 5 Dangerous Social Media Challenges: Know the Risks and Stay Safe [Internet]. Cook County Emergency Medicine Residency;Available from: https://cookcountyem.com/blog/2023/12/1/the-toxic-shelf-5-dangerous-social-media-challenges-know-the-risks-and-stay-safe
In today's digital age, social media has brought us closer together but has also given rise to new and potentially life-threatening challenges. From the seemingly harmless to the shockingly dangerous, let's debunk myths, explore toxidromes and symptom presentations, understand the pathophysiology, and discover treatments for five alarming social media challenges. Let’s communicate with patients and emphasize why these challenges are truly dangerous!
Challenge 1: The Benadryl Challenge
The Challenge: Using Benadryl for its supposed euphoric effects (1).
The Myth: Belief that Benadryl can induce euphoria safely.
Benadryl, or diphenhydramine, is an antihistamine that acts as an H1 receptor antagonist (2). It is structurally related to histamine and competes with histamine for H1 receptor sites. Anticholinergic effects result from its ability to block the action of acetylcholine at muscarinic receptors, leading to symptoms like dilated pupils, dry and flushed skin, tachycardia, and urinary retention. Symptoms include sedation, seizures, hallucinations, EKG Changes (QRS widening, QTc prolongation). The mainstay of treatment is typically supportive, including ABCs, IV fluids, and benzodiazepines for symptomatic control. Activated charcoal can be beneficial, even delayed presentations, given slowed gut motility secondary to anticholinergic toxicity. An EKG should be obtained to evaluate QRS widening, after which sodium bicarbonate and potassium repletion to a goal of 4.0 mEq/L. Although physostigmine prevents irreversible binding of anticholinergics to muscarinic receptors, it is not currently available in the US.
Challenge 2: The Borax Challenge
The Challenge: Using Borax for arthritic pain relief and GI cleansing (3).
The Myth: Borax has health benefits, including cleansing the GI system
Borax, a compound commonly found in cleaning agents and pesticides, acts as a general irritant to mucous membranes (4). Ingested borax can lead to gastrointestinal irritation, characterized by symptoms such as blue-green, vomiting, diarrhea, abdominal pain, and an erythrodermic rash “Boiled-Lobster appearance”. Renal toxicity and neurologic toxicity may additionally occur, including hyperactivity, agitation, and seizures. The mainstay of treatment is typically supportive, including ABCs, IV fluids, and benzodiazepines for symptomatic control. There is no specific antidote, but hemodialysis can be considered in massive ingestions with renal failure.
Challenge 3: The Tide Pod Challenge
The Challenge: Ingesting laundry detergent pods for amusement (5).
The Myth: Teens daring each other or accidental ingestions.
Laundry detergent pods, like Tide Pods, contain a combination of ingredients, including ethoxylated alcohols and propylene glycol (6). These components can act as cellular toxins and irritants, resulting in acute renal failure, anion gap metabolic acidosis, and lactic acidosis. Toxidromes can vary based on the exposure type. Ingestion, the more common in these challenges, results in vomiting, coughing/bronchospasm, aspiration, lethargy, seizure, coma, pulmonary edema, and gastric and esophageal burns. Dermal and ocular exposure result in irritation and burns/corneal injury. As always, treatment begins with ABCs followed by intubation if decompensation occurs, steroids or nebulized epinephrine for airway involvement, and possible hemodialysis in severe cases. GI should be consulted to assess internal injury. Ocular and dermal exposures involve decontamination and evaluation of significant injury.
Challenge 4: The Apricot Seeds Challenge (Little Cyanide Pellets)
The Challenge: Ingesting apricot seeds to cure cancer or its effects (7).
The Myth: Apricot seeds possess miraculous cancer-curing properties.
Apricot seeds contain amygdalin, a cyanogenic glycoside. When ingested or pulverized, amygdalin releases cyanide, a potent cellular toxin that interferes with cellular respiration by binding to ferric ions in the mitochondrial cytochrome complex IV. This disrupts oxidative phosphorylation and forces cells into anaerobic metabolism, leading to lactic acidosis and a cascade of severe symptoms (8). Symptoms secondary to ingesting apricot seeds include headache, dyspnea, confusion, seizures, bradycardia, cherry-red skin, and almond breath odor. Tachycardia and hypertension can rapidly become bradycardia and hypotension. Treatment includes ABCs, decontamination, and hydroxocobalamin (1st line) or Sodium nitrite/thiosulfate (2nd line). There is no data supporting using activated charcoal or NAC, and hyperbaric O2 and hemodialysis should be avoided.
Challenge 5: The Nutmeg Challenge
The Challenge: Seeking euphoria and hallucinations through nutmeg consumption (9).
The Myth: Nutmeg induces hallucinations safely.
Nutmeg contains myristicin, the primary psychoactive compound responsible for the challenge's effects (9). Myristicin is metabolized in the body into compounds like MMDA (structurally related to MDMA) and others with hallucinogenic properties (greater than mescaline). Additionally, nutmeg contains compounds like linalool, safrole, isoeugenol, and eugenol, which have serotonin agonism, weak MAOI properties, and GABAergic activity, and thus may lead to symptoms such as hallucinations, seizures, and altered mental states. Symptoms typically occur within hours and include abdominal pain and vomiting in addition to the above neuropsychiatric symptoms. A toxic dose can be reached after ingesting 1-3 seeds (approximately 7g per seed). The mainstain of treatment is primarily supportive, including ABCs and benzodiazepines for symptomatic relief.
Understanding the underlying pathophysiology of these challenges is crucial for recognizing their potential risks. Stay informed about these social media challenges, share this knowledge with friends and family, and prioritize safety and well-being over online trends. Your health is the most valuable trend to follow.
Authored by Vishal Mittal, MD and Steve Aks, MD
References:
Faisal Syed Minhaj P, James Leonard P. Dangers of the TikTok Benadryl Challenge [Internet]. Contemporary Pediatrics. 2021 [cited 2023 Sep 25];Available from: https://www.contemporarypediatrics.com/view/dangers-of-the-tiktok-benadryl-challenge
Huynh DA, Abbas M, Dabaja A. Diphenhydramine toxicity - statpearls - NCBI bookshelf [Internet]. National Library of Medicine. [cited 2023 Sep 26];Available from: https://www.ncbi.nlm.nih.gov/books/NBK557578/
Bendrix A, Yang A. Drinking borax is latest TikTok trend medical experts are debunking [Internet]. NBCNews.com. 2023 [cited 2023 Sep 25];Available from: https://www.nbcnews.com/health/health-news/drinking-borax-tiktok-trend-medical-authorities-debunk-rcna95526
Mlodzinski SR, Holstege CP. Man with altered mental status and rash. Annals of Emergency Medicine 2016;68(3):387–98.
Tanishq Suryavanshi BB. Tide Pod Challenge: Managing caustic laundry pod ingestions [Internet]. CanadiEM. 2018 [cited 2023 Sep 25];Available from: https://canadiem.org/tide-pod-challenge-managing-caustic-laundry-pod-ingestion/
3. Weiss ST. TOXCard: Laundry detergent pods (ldps) [Internet]. emDOCs.net - Emergency Medicine Education. 2018 [cited 2023 Sep 25];Available from: http://www.emdocs.net/toxcard-laundry-detergent-pods-ldps/
Suchard JR, Wallace KL, Gerkin RD. Acute cyanide toxicity caused by apricot kernel ingestion. Annals of Emergency Medicine 1998;32(6):742–4.
Cyanide poisoning [Internet]. Cyanide Poisoning - Respiratory - Medbullets Step 1. [cited 2023 Sep 25];Available from: https://step1.medbullets.com/respiratory/322197/cyanide-poisoning
TikTok nutmeg challenge leads to intoxication [Internet]. ACEP. [cited 2023 Sep 25];Available from: https://www.acep.org/toxicology/newsroom/june-2022/tiktok-nutmeg-challenge-leads-to-intoxication