A boy ate 25 laxative brownies in one hour. This is what happened to his kidneys. [siren wailing] BG is a 14-year-old boy presenting to the emergency room with an abnormal heart rate. His older brother Nate tells the admitting nurse that BG had defecated eight times in the last ten hours before stumbling around, confused. You see, BG and his friends decided to challenge each other —”First to poopoo wears a tutu”— where friends would eat ten laxative-filled brownies within 15 minutes, and the first two to poop would be deemed “full of crap”, and will have to wear a tutu to school the next day. Clearly, this was for jokes and memes on behalf of 14-year-olds. It didn’t help that Nate—the older brother—agreed to buy the laxatives over the counter, and an older sister agreed to bake the brownies. BG, the “alpha male” in his group of friends, was not only gonna win the competition, HE was going to eat the most brownies, each one having the equivalent of two laxative tablets. You’re only supposed to take two as the recommended adult dose. Contest day. The brownies are baked, and the boys, with fresh-faced determination, decimate them, eager to show each other up. 20 minutes after finishing ten Brownies each, one of the boys didn’t feel well.He tried as hard as he could to resist the urge to defecate, but he gave him quickly.Some of the other boys were feeling uncomfortable, too.And in the back of his mind, BG didn’t feel well, but the need to show up his friends was greater than his urge to use the bathroom.He laughed at the others, called them derogatory names and ate five more Brownies. One of the boys was clenching his stomach.He was feeling major abdominal cramps.It was uncomfortable.He was on the verge of tears BG Laughed in his face and ate five more Brownies to show him up.A total of twenty Brownies now. Finally, the second boy gives in and goes to the restroom. He was the final loser. The other boys –now free to poop without fear of losing– all go use the bathrooms.And BG to show up the others, ate five more Brownies for a total of 25 before finally using the bathroom himself. It’s several hours later.The two boys who lost the competition are feeling great. Those who fought the urge to poop aren’t feeling so great and worst of all, BG is acting weird.It started with him slurring his words and tripping over his feet.These started appearing after the sixth time he defecated. Around this time, he reported that his urine looked like coffee, that the stools became diarrhea and that he felt his right calf muscle was sore and cramping.He was found gasping for air as he complained that his heart was racing. He also started to develop a massive headache and was found gripping his head in pain. The friends laughed that BG Was pooping his brain out. But after the eighth time in the bathroom, he didn’t come out and in fact, an hour later, he was found unconscious on the floor. The friends immediately called for an ambulance to bring him to the emergency room where we are now. Given This past Medical History There’s Several Clues As to What’s happening first Bg is suffering from hypokalemia Hypo Meaning Low Kayleigh referring to potassium are more Formally camión As Is Shown By its symbol on the periodic table of Elements and Emia Meaning presence in Blood Low potassium presence in Blood Bg Clearly Overdosed on laxatives When he took 25 times the Recommended Adult dose in the Brownies the laxative he consumed was set aside a Natural stimulant It Works By causing the muscles of the colon to Contract Helping You Pass a Stool But It also softens That Stool By drawing Water into your colon That’s a problem Because Your Body Water Is a Soup of Several chemicals an important One getting Depleted in Bj’s body by the laxatives is Potassium Potassium Like Sodium above it on the periodic table is important in signaling in the body telling Tissues and organs to do Things One important Signal on Behalf of Sodium and Potassium Is muscle contraction Take for Example These frog legs that muscle is physiologically Similar To Human Skeletal Muscle When Salt or sodium Chloride is put on these legs They twitch and contract despite there being no brain Attached to these legs to control them so sodium Helps promote muscle contraction on The Other hand Potassium Promotes Muscle Relaxation a Lot of It present means that Your Muscles relaxed for a Very long time and too little present means that your Muscles won’t Stop contracting One Part of Lethal Injection you Know that One form of capital Punishment is potassium Chloride Injected Directly to the Heart Too from contracting That Kind of Injection Doesn’t tense your Heart Up it Just relaxes It Forever You can Start to see the problem here? If potassium Is low in BG’s blood and his muscles would Have a Hard time relaxing? Then He’s having Cramps both in his abdomen and his right calf Muscle His Heart Is a Muscle too and it’s beating Irregularly Because It Doesn’t have sufficient resources to signal relaxation When His heart is beating Irregularly The Amount of Oxygen getting to his brain is decreased he’s drifting in and out of consciousness something Very severe is happening Bg is suffering from Rhabdomyolysis Rhabdo Meaning striated or in this case Skeletal Maya Meaning muscle and Lysis meaning Break down Skeletal muscle Breakdown This is life-Threatening and It’s a Medical Emergency This is happening Because of Bg’S hypokalemia Onset By laxative overdose With Low potassium in his blood Every time he contracts any of his Muscles Which is Every time he moves or Every time he breathes Less Potassium present in the Blood Confuses the muscle cells and They start to malfunction Instead of potassium entering the cell to signal relaxation The Muscle Allows in sodium Now the interesting Thing about Sodium is that It creates something called an osmotic gradient Which means Wherever Sodium is water will flow Towards it in this small science Experiment i dissolve salt in this Water and Place it into a Tube i Submerge The Tube in a Pool of Water That has no salt Dissolved in It and You’ll see that Water Flows into the tube That Water Follows Sodium so bg’s muscle cells are not Only malfunctioning They’re also Swelling With Water Not Only as Bg Having Water Exit His intravascular Space Through His colon But another large Part of His body Water Up to 12 liters is entering into his muscle causing Massive Dehydration When you’re dehydrated to this degree your Kidneys Which are responsible for filtering your Blood Removing Wastes and Maintaining Electrolyte balance Detect This and They constrict Their own Blood Vessels in an Attempt to conserve body Water This is called Vasoconstriction This can damage The Kidneys as Renal Perfusion is decreased There’s Less Blood going to the Kidneys so less Oxygen is getting to the tissue Which can cause cell Death But Here’s another problem Now that the muscle cells are starting to rupture they’re releasing protein an Important One Known as Myoglobin Myoglobin Causes something Called Lipid peroxidation Which Destroys The outer membrane of Cells in General Myoglobin is build Up can be toxic to the rest of Your body but Where would it build up as the Blood Flows Around in Your body You could Say Maybe Myoglobin could accumulate in your Heart But there’s nothing there to catch it Protein Is a large molecule and Would Likely Just Pass Through The chambers of The heart There isn’t a reservoir where it can accumulate But how about the liver well the liver Breaks proteins down so it’s probably not going to build Up there either But What about the Kidney the Nephron the functional unit of the Kidney Contains Tubules These Filter Out Your blood and act As a Net To catch The toxins in your blood screening them into the urine it’s Kind of like This strainer if Myoglobin Is a large molecule then it’s Likely to get caught in the tubules of the Nephron and can cause the Breakdown of cell Membranes so when Myoglobin Reaches the Nephron it Builds Up Gunks Up The tubules and ruptures the Membranes of Your Nephrons it’s something like dissolving The net of This strainer We Call This acute Kidney Injury The Reddish Brown urine is because myoglobin Contains heme a Compound that Has Iron That’s responsible for Making Your Blood Red When Exposed to oxygen the myoglobin Builds Up in the Nephron and Spills Into Your urine and once It starts to damage the tubules This indicates That Bg’s Rhabdomyolysis Is Very severe because he’s a Fourteen-Year-Old Boy he hasn’t finished puberty yet Meaning his muscle mass Is lower Than an adult Man in Pediatric Rhabdomyolysis Boys have a Higher risk of getting It Than Girls Because of Decreased female Muscle mass but also For pediatric Patients The discolored urine Doesn’t Usually Appear Because It takes Upwards of 200 grams of muscle to be lysed for it to Appear That’s Nearly Half a Pound of muscle and it’s Very Significant for any 14-Year old and the fact that vg has it precipitates the Urgency of the Situation While the muscle damage can Be fixed This Kidney Injury is irreversible Those Nephrons won’t come back They don’t regenerate Bg’s capacity to filter metabolic Wastes in his blood is quickly waning and This A problem When the Kidneys aren’t removing Wastes it’S a Vector for Things like metabolic Acidosis where the ph of the blood decreases This can Cause Nutritional Deficiency Impaired enzymatic activity and Increased Mortality Chronic Kidney disease Which can Arise Out of This Injury Precipitates uremic Bone syndrome a disorder That Deforms the Bones and weakens them causing them to fracture easily This isn’t something that you want To have While you’re still growing as a Human Being iF Your Kidneys don’t Function Your Body down to its Bones Will Rot Away and eventually You’ll die in a Pool of Your own waste that Should Have Been your urine All of This Seems to be a non-intuitive series of events Rhabdomyolysis Is both a multifactorial and an ancient problem eating Too Much licorice Candy can cause one To have Dark urine and Muscle Aches? Licorice Contains Glycyrrhizic Acid a Compound That Keeps Cortisol Levels High in the body Which leads to hypokalemia Causing Muscle Breakdown and ultimately Rhabdomyolysis This Was documented as far back as 300 Bc by the ancient chinese Who used licorice as a Remedy for digestive disorders They Called It striped muscle Dissolution The old testament of the Bible Numbers 11 31 to 34 Jews ate quail during Their Exodus from Egypt and Suffered a Great plate Quail in that Region Eat Hemlock herbs and Seeds During Their Spring Migration Across The mediterranean sea Hemlock Contains Cony the Poison that Was used to execute socrates and that Causes Rhabdomyolysis Napoleon occupied Berlin in 1806 his soldiers heated Their Living quarters with Burning coal They Breathed in carbon Monoxide gas Because of Bad Ventilation Carbon Monoxide Binds Strongly to the hemoglobin in blood and Starves your Muscles of Oxygen Causing The tissue to necrosis or die resulting in Rhabdomyolysis back then They Called It limb Gangrene in world war two crush syndrome where the physical destruction Through Crushing of Muscle tissue from Falling objects due to bombings Induced Bruising Underneath severe muscle damage is Known as Rhabdomyolysis so this isn’t a Direct problem as non-intuitive as It may be that overdosing on laxatives something that Makes You Poop Causes Your Muscles to dissolve in your body thus damage your Kidneys Well at The Very least The treatment for Bg is Very Simple We Just Go by the symptoms in this case we can Save his muscles and Kidneys but he’ll have to bear the pain of Laxative overdose Until It passes Through His body We’ll give him potassium supplement to raise his blood potassium levels we’ll have to monitor It constantly Because Too Much Potassium Will Stop his heart and too Little Got him into the situation that he’s in right Now Keeping His potassium stable will prevent Any more of His Muscles from breaking down in his body and Stop any further release of Myoglobin Second Because His Kidneys have vasoconstricted Because They detected low Blood volume then We Correct That By infusing Water into his veins We won’t give it to him orally Because the absorption Will be Too slow in this Way it’ll replace his body water and increase the amount of fluid going into his Kidneys Increasing Renal Perfusion Allowing for more Oxygen to get into that tissue it’s Kind of like How we Wash something out When things Get trapped in a net with enough Fluid replacement Will minimize any Further Renal damage to Bg Now while that Renal damage Will stay Forever in his medical History At The Very least his Kidneys will still Function After Monitoring and Symptomatic treatment a Strong Lesson Learned and An Experience That Would Never Be lived down amongst his friends for the rest of His life Bg Because he was so young was Able to recover from His laxative Induced hypokalemia and resulting Rhabdomyolysis Please don’t ever Take more Than the Recommended dose of Laxatives for anything it’s Just Not Worth the consequences Thank you so much for watching take care of Yourself and be Well