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The rise of social media has transformed how people — especially children and adolescents — access information, interact with their surroundings, and make decisions about their health and well-being.

It is within this digital context that viral challenges have emerged. These social media trends encourage users to perform unusual, risky, or extreme actions to attract attention. A notable example is the “Blue Whale” challenge, which went viral between 2016 and 2017. This challenge involved a series of tasks, including self-harm, social isolation, and even suicide encouragement. The “Blue Whale” challenge has been linked to several adolescent deaths worldwide, highlighting the devastating impact such content can have on young people.

One of the most recent viral challenges, “the challenge of taking the strongest medication you have at home,” has gained popularity on platforms like TikTok and Instagram. It attracted national media attention following the case of a teenage girl from Valencia, Spain, who was admitted to the intensive care unit of Manises Hospital in Manises, Spain, due to carbamazepine poisoning, a drug used to treat epilepsy.

To participate in the challenge, the teenager ingested as much of the strongest medication available at home. Upon arrival at the hospital, she was in a comatose state. Although doctors managed to save her life, her condition was deemed “life-threatening,” according to María Victoria Ordoño, MD, and María Sinisterra, MD. These doctors presented the case at the 71st Congress of the Spanish Association of Pediatrics in June in a session titled “The Other Side of Social Media: Viral Challenges, Fatal Consequences.”

During her hospital stay, the patient developed aspiration pneumonia, which responded well to intravenous antibiotics. After regaining consciousness, she admitted to ingesting the carbamazepine voluntarily as part of the viral challenge with her peers. The challenge involved demonstrating courage by ingesting the strongest medication available at home. She was evaluated by a child and adolescent psychiatrist, who confirmed that the teenager showed self-awareness of the incident and that her intent was not suicide but participation in the viral challenge. She continues to receive follow-up care from social work and child and adolescent psychiatry, with no new risk behaviors observed.

“The dangers of viral challenges like this one need to be highlighted, especially for the pediatric population. The need for group approval often drives these dangerous behaviors,” warned the doctors during their presentation.

Paracetamol Challenge

Another viral challenge circulating on TikTok and Instagram is the “Paracetamol Challenge,” in which adolescents challenge each other to ingest excessive doses of paracetamol (acetaminophen in the US). The goal is to see who can stay in the hospital the longest or who shows the most “resilience.” This challenge has been primarily reported in the United States, where an 11-year-old child tragically died earlier this year from participating. However, similar cases have also been reported in the United Kingdom, France, Belgium, Switzerland, and Spain, according to health and pharmaceutical agencies.

The French National Agency for the Safety of Medicines and Health Products issued a warning earlier this year for healthcare professionals and parents, stating that paracetamol overdose can cause severe, sometimes irreversible liver damage, which may require a liver transplant. In fact, paracetamol poisoning is the leading cause of drug-induced liver transplants in France. Overdoses can also severely affect the kidneys and pancreas.

In an interview with Agencia EFE, Spain’s international news agency, director general of Public Health at the Government of Aragón and a pharmacist by profession, emphasized the importance of raising awareness about the risks of consuming medications like paracetamol in doses higher than recommended as this can lead to permanent damage or even death.

Cooking With Medications

The “Sleepy Chicken,” also known as NyQuil Chicken, is another viral challenge spreading on social media. This challenge involves cooking chicken breasts in cough syrup, such as NyQuil, a medication used for flu and cold relief. NyQuil contains acetaminophen, dextromethorphan (a cough suppressant), and doxylamine (an antihistamine). Some videos show people eating the cooked chicken, but the primary goal of the challenge is to inhale the vapors released during cooking to induce drowsiness.

Health authorities, including the US FDA, warned in 2020 that boiling medications can concentrate their active ingredients, alter their chemical properties, and release toxic fumes. Inhaling these vapors can expose individuals to uncontrolled doses, potentially leading to severe lung damage, overdose, liver damage, central nervous system depression, and even death.

Sleep or Stay Awake Challenge

One of the most common challenges on social media platforms like TikTok is known as “Last to Fall Asleep Wins.” In this challenge, participants consume sedative medications, such as clonazepam, to compete for who can stay awake the longest. This challenge, also referred to as the “Clonazepam Challenge,” has become especially widespread in Latin American countries. It has led to adolescents experiencing intense drowsiness, dizziness, nausea, respiratory changes, and, in many cases, hospitalizations.

In 2023, 15 children aged 10-11 years were hospitalized in Guanajuato, Mexico, after participating in this challenge at a local elementary school. According to authorities, the minors irresponsibly ingested the anxiolytic drug without medical supervision, attempting to stay awake despite the drug’s sedative effects. Four of the children required severe treatment in the hospital, while the others were transferred to various health centers with their families.

Viral Challenge for Hallucinations

The “Benadryl Challenge” involves ingesting excessive doses of diphenhydramine (Benadryl), an over-the-counter antihistamine, to induce hallucinations and record the effects. This practice has led to multiple hospitalizations and deaths since 2020. One of the most tragic cases occurred in April 2023, when a 13-year-old boy in Ohio died after consuming 12-14 pills — approximately six times the recommended dose — and fell into a coma for 6 days.

In 2020, a 15-year-old girl in Oklahoma also died from an overdose related to this challenge. Additionally, three other minors were hospitalized in Texas for similar reasons. At high doses, diphenhydramine acts as a central nervous system depressant, leading to seizures, delirium, arrhythmias, coma, or even death. The FDA issued official alerts warning about the deadly risks associated with this challenge. Social media platforms, such as TikTok, also blocked the hashtag linked to this challenge in 2020, though experts caution that the content may still circulate under different names.

Clinical and Ethical Implications

Emergency services are increasingly encountering patients with nonspecific symptoms after ingesting substances or engaging in dangerous behaviors driven by viral challenges. The situation is further complicated during anamnesis as patients may omit the true cause of their exposure due to shame, fear of social judgement, or lack of awareness regarding the medical severity of the viral challenge. This lack of information can delay or distort the initial diagnosis, compromising timely and effective clinical decision-making.

The initial therapeutic approach, particularly in emergency settings, requires a multidisciplinary approach with high clinical suspicion and sensitivity to risk behaviors motivated by psychosocial factors. The absence of standardized protocols for such cases adds another layer of difficulty.

From an ethical and legal perspective, the issue is complex. Some of the substances involved are over-the-counter, while others require a prescription. This necessitates a careful review of prescription protocols, home storage practices, and clinical follow-up, particularly for pediatric and adolescent patients. There is also a growing need to discuss shared responsibility among healthcare professionals, caregivers, and digital platforms in preventing these behaviors that put young people’s health at risk.

This story was translated from El Medico Interactivo.