Have you heard of food challenges?
Social media shapes our lives these days. Trends on social
media force many of us into activities that may or may not be appropriate.
Similarly, many food challenges have made emergency physicians even busier.
One such example is of a 47-year-old man who suffered severe chest and abdominal pain due to vigorous vomiting and retching after consuming ghost pepper puree in a hamburger as a food challenge. The patient was rushed to the emergency department.
On examination, the patient had epigastric tenderness, increased blood pressure of 174/106 mm of Hg, increased heart rate of 106/min, respiratory rate of 18/min, and saturation of oxygen of 96%.
Laboratory tests revealed hemoglobin of 15.1 g/dL, hematocrit of 43.3%, white blood cell count of 15.7 x 103/µL, platelet count of 221 x 109/L, and creatinine of 1.14mg/dL.
In the emergency department, chest Xray was performed, which showed signs suggestive of left-sided pleural effusion and diffuse patchy infiltrates were noticed. Pneumomediastinum and air around the distal esophagus were noticed on the computed tomography scan. The signs on the CT scan were suggestive of spontaneous esophageal perforation and a left-sided pneumothorax.
The patient was rushed to the operating theatre after intubation. Intraoperatively, a 2.5 cm tear was noticed in the distal esophagus, along with a fluid collection containing food debris ( a mix of hamburger, onions, and green vomitus) in the mediastinum, and pneumothorax on the left side.
On the 14th day of admission, the patient was extubated. He was discharged on the 23rd day of admission with a gastric tube in place.
So can ghost pepper kill?
Ghost pepper surely is the hottest pepper in the world! 400 times hotter than tabasco sauce.
The concentration of capsaicin determines the spicy sensation, and the unit by which the spiciness is measured is called SHU, i.e., Scoville Heat Unit. The spice level of ghost pepper measures 1,041,427 SHU. This level of spice is so strong that a single seed can burn the tongue with spice for about 30 minutes. But the question persists, can ghost pepper kill us?
A large amount would be required to do so! A consumption of three pounds has a higher chance of killing a 150-pound man. So as long as the ghost pepper consumption doesn’t exceed 1/50th of the person’s weight, it is less likely to cause death. This doesn’t pertain to the medical complications associated with the consumption of ghost peppers. Death may not occur, but complications do
A large spicy meal may cause a life-threatening emergency like spontaneous esophageal rupture, also called Boerhaave syndrome which is fatal in up to 40 percent of the cases, and if left untreated the mortality rate is quite high.
So the take-home message is to avoid large consumption of ghost peppers. If following a trend of food-challenge, choose wisely!
Ann Arens, M. L.-Y. (2016, December 01). Esophageal rupture after ghost pepper ingestion. Retrieved from The Journal of Emergency Medicine: https://www.jem-journal.com/article/S0736-4679(16)30256-6/pdf