News Release

Teenage boy hospitalized by stimulant chewing gum

Peer-Reviewed Publication

The Lancet_DELETED

The dangers of stimulant chewing gums containing caffeine are highlighted in a Case Report in this week's edition of The Lancet, which describes how a teenage boy was hospitalised by excessive consumption. Furthermore, the authors conclude that as such products are readily available, the risk to children is high. The Case Report was written by Dr Francesco Natale, Second University of Naples and Monaldi Hospital, Naples, Italy, and colleagues.

In November 2008, a 13-year-old boy was taken to the emergency department of Monaldi Hospital, after he had returned home agitated and aggressive, in contrast with his normal mood. He denied feeling stressed or taking drugs or stimulants. He had abdominal discomfort, increased and painful urination, and prickling sensations in his legs. On examination, he was restless, with rapid heartbeat (147 beats per min [bpm]), rapid breathing (25 breaths per min) and raised blood pressure (145/90mm Hg). His chest scan and blood test results were normal and he tested negative for illicit drugs. His condition improved overnight without treatment and he was discharged the next morning, his only unusual symptom being slow heartbeat (40 bpm).

Later the same day, his mother returned to the hospital with two empty packets of stimulant ('energy') chewing gum she had found in her son's bag. He admitted he had consumed it at school, all within a four-hour period. The gum contained 160 mg caffeine per packet, and thus two packs (320 mg) would contain slightly more than three regular cups of coffee (at 100mg per cup). The mother said her son did not usually consume caffeine-rich beverages or food. He returned to hospital for a check-up a few days later, appearing sleepy and sluggish. He had been absent from school for three days. Examination showed he still had slow heartbeat (45 bpm) and a low left-ventricular ejection fraction (55%) Normal values for a boy of this age would be a heartbeat of 55-60 bpm and an ejection fraction of 65—70%. Over the next five days, he recovered, and was well on his last examination in December 2008.

The authors say: "The transient constellation of signs and symptoms in our patient was most likely secondary to acute intoxication of stimulant chewing gums." While blood caffeine levels were not measured directly, the authors say the boy met the criteria for diagnosis of caffeine intoxication—namely consumption of at least 250mg of caffeine followed by the onset of at least five specific features*. They add that 320mg of caffeine for this boy (weight 45kg) would be equivalent to 10 cups of tea for a 70kg adult across four hours. They say: "Our patient...presumably had high caffeine sensitivity in view of his low habitual caffeine intake, so 320mg was a substantial amount of caffeine."

They conclude: "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."

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Dr Francesco Natale, Second University of Naples and Monaldi Hospital, Naples, Italy T) +39 0817062683 / +39 0817064234 E) natalefrancesco@hotmail.com

For full Case Report, see: http://press.thelancet.com/chewinggum.pdf

Note to editors: *Agitation, aggressiveness, abdominal discomfort, increased urination, prickling sensations in legs


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