It was a reasonably quiet night in the Emergency Department. Busy enough to make the time pass but not so busy that I wished I was somewhere else. I was able to respond to the distraught young man when he arrived.
At first, I wasn’t sure what the problem was. He was barely able to give a history as he was anxious, diaphoretic, coughing, crying, writhing about while clutching his chest, and intermittently vomiting. He was producing copious amounts of clear drainage from his nose and eyes. His face was red, and his pulse was elevated, other vitals were normal, as was his oxygen saturation.
While getting an IV started, I was able to gather the history that he was inspired by the Jackass movie to do something outlandish in an effort to achieve stardom. He and his adolescent buddies had come up with the idea that he should drink a shot glass of “Da Bomb” and video it. This is an intensely hot sauce that is meant to be used very sparingly in spicy dishes.
After drinking about an ounce of this stuff, he began to experience symptoms of severely painful burning mouth, runny nose and eyes. He began sweating because of a feeling of heat. Over the next few minutes, the pain continued to intensify and he began to throw up which was followed by burning chest pain. He drank water and that made the symptoms worse. He could no longer tolerate it and thought he was dying so he had a friend drive him to the ER.
Capsaicin is what makes peppers hot. It is an oil in the pepper plant that attaches to receptors on pain fibers of nerves that sense temperature. The nerve stimulation fools the brain into reacting as if the tissues in contact with the capsaicin were indeed being burnt. As a result, blood vessels get dilated to release the heat and the body sweats. The body tries to purge the perceived toxin by making the nose run, eyes water, as well as initiating vomiting and eventually diarrhea if the exposure is great enough.
Unfortunately, the vomiting of acid from the stomach can cause damage to the esophagus and reintroduce the capsaicin to the esophagus, upper airway, and mouth. The capsaicin won’t directly cause ulcers or damage, but it can make the injury from acid more painful. The excess secretions with vomiting combined with extreme pain and numbness of the upper airway can potentially compromise the airway and result in aspiration. Asthmatics are at risk for bronchospasm from high dose capsaicin.
The intensity of capsaicin in peppers is measured in Scoville units. A typical hot sauce like Tabasco is about 2000 Units. Da Bamb is 1.5 million units. The amount of exposure this young man had would be intense for even the most experienced and acclimatized palate.
Water can actually make the symptoms worse because it just spreads the capsaicin around further. It doesn’t dilute it because capcaisan is an oil which doesn’t mix with water. It would have been better for him to drink milk or eat some bread, but given the level of exposure even that probably would not have been that effective.
His symptoms settled down with IV Dilaudid, Ranitidine, and Ondansetron. He was eventually discharged home in good condition. He was cautioned to expect some anal burning and possibly diarrhea to follow the next day. He indicated he had learned his lesson and was done with trying to achieve fame in this manner.
Marven Ewen, MD