Healthy young man lost consciousness after drinking cold drink: a case report

Dr Arandjelović, O. at the University of St Andrews, North Haugh, St Andrews, Fife, KY16 9SX, UK  has reported a rare case of Cold beverage-induced vasovagal syncope.The case has appeared in the Journal of Medical Case Reports.  

Swallowing-induced syncope is rare and there are few case reports of it in the existing medical literature. Even rarer are instances involving young and healthy individuals, with no existing pre-conditions or apparent risk factors.

A healthy 32-year-old white man was examined after suffering from a syncope episode. The incident took place following a visit of 2–3 hours' duration to a wildlife park on a sunny and hot day (approximately 37 °C in the shade) in a café while he was resting and consuming a cold carbonated beverage. He reported that he had been feeling fine until he swallowed the first mouthful of the beverage when he experienced a sharp painful sensation in his chest, followed by a blurring of vision.

Within a few seconds, he lost consciousness. Due to the quick reaction of one of the individuals accompanying him, he (seated at the time) was prevented from hitting his head and was slowly lowered to the ground. He quickly regained consciousness and had no recollection of fainting. Except for a feeling of lightheadedness, all ill effects disappeared promptly.

At the time of examination, approximately 30 minutes following the syncope, his body mass was 102 kg and height 188 cm with a body mass index (BMI) of 28.9. He self-reported an active lifestyle and regular involvement in challenging resistance training (4–5 times a week), corroborated by his high lean body mass (LBM) and low body fat (BF) (8%); there was no history of recreational or performance-enhancing drug use, and no use of medications (either prescription or over-the-counter).

He had experienced no prior episodes of syncope, although he did note experiencing sensations similar to those leading to the present episode upon swallowing cold carbonated beverages in the past; the frequency of these sensations was not deemed unusual or as warranting further investigation (self-estimated as being less frequent than once per annum).

At the time of examination, his blood pressure was 128/77 mmHg and his resting heart rate (RHR) was 74 beats per minute (bpm). He reported a history of low blood pressure in his family, both on the maternal and paternal sides, and his somewhat elevated systolic measurement was attributed to the weather conditions and the overall arousal concerning the episode. Taking into account the entirety of the context and presented symptoms, that is, the patient's state at the time of examination, health condition, and symptoms, and the one-off nature of the incident, the syncope was attributed to vagus nerve overactivation affected by oesophagal stimulation.

In a 5-year follow-up, he reported no recurrence of syncope (swallowing induced or otherwise) but confirmed several more instances of the aforementioned unpleasant sensations (including sharp transient pain, blurry vision, and lightheadedness but no actual loss of consciousness) all associated with the swallowing during the ingestion of cold carbonated drinks. Computed tomography (CT) scans of his brain and thorax revealed no abnormalities, and tests of his thyroid revealed normal functioning.

For further reference log on to:DOIhttps://doi.org/10.1186/s13256-020-2358-3