A case report written by Dr Francesco Natale and his colleagues, from the Second University of Naples and Monaldi Hospital, Naples, Italy, reports on the dangers of stimulant chewing gums containing caffeine. The report published in this week´s edition of The Lancet describes the story of a teenage boy hospitalized after excessive consumption of this type of product. The authors warn about the high risks of stimulant chewing gums that are widely available to children.
A thirteen year old boy was admitted to the emergency rooms of the Monaldi Hospital after feeling abnormally agitated and aggressive, in November 2008. The boy reported having abdominal discomfort, increased and painful urination, and prickling sensations in his legs. He denied feeling stressed or taking drugs or stimulants. During his examination, he was agitated, with rapid heartbeat of (147 beats per min [bpm]), rapid breathing (25 breaths per min) and raised blood pressure (145/90mm Hg). He tested negative for illicit drugs and his chest scan and blood test results were normal. The next morning, his condition had improved without treatment and he was discharged. His only unusual symptom was a slow heartbeat (40 bpm).
On the same day, the mother found in her son´s bag two empty packets of stimulant (energy) chewing gums. He later admitted he had consumed it all at school within a four-hour period. The gum contained 160 mg caffeine per packet. Two packs (320 mg) equal slightly more than three regular cups of coffee (at 100mg per cup). The mother explained that her son did not usually consume caffeine-rich beverages or food. A few days later, he returned to the hospital for a check-up, feeling drowsy and tired. He did not attend school for three days. The examination showed he still had slow heartbeat (45 bpm) and a low left-ventricular ejection fraction (55%). For a boy this age, normal values would be a heartbeat of 55-60 bpm and an ejection fraction of 65-70%. During the next five days, he improved, and was well on his last examination in December 2008.
The authors explain: “The transient constellation of signs and symptoms in our patient was most likely secondary to acute intoxication of stimulant chewing gums.” The blood caffeine levels were not measured directly. But the authors say the boy met the criteria for diagnosis of caffeine intoxication. Specifically, it is consumption of at least 250mg of caffeine followed by the onset of at least five specific features (agitation, aggressiveness, abdominal discomfort, increased urination, prickling sensation in legs). They explain that 320mg of caffeine for this boy (weight 45kg) would be equal to ten cups of tea for a 70kg adult during four hours. “Our patient…presumably had high caffeine sensitivity in view of his low habitual caffeine intake, so 320mg was a substantial amount of caffeine,” they write.
They say in conclusion: “It was unlikely that…other ingredients of the chewing gum played a part in this case, because their doses were low or they would induce different signs and symptoms from those found in our patient. The use of stimulant chewing gum should be considered in cases of caffeine intoxication. The risk of intoxication is high in children and teenagers in view of general caffeine-naivety, and the unrestricted sale of these substances.”
“When chewing gum is more than just a bad habit”
Francesco Natale, Chiara Cirillo, Giovanni Maria Di Marco, Lucia Scotto di Vetta, Luigi Aronne, Alessandro Siciliano, Rosa Mocerino, Michele A Tedesco, Paolo Golino, Raffaele Calabrò
Lancet 2009; 373: 1918
Written by Stephanie Brunner (B.A.)