A Bitcoin Miner Heatstroked In His Sleep. This Is How His Organs Shutdown CW is a is a 23 year old man, presenting to
the emergency room, unconscious. His mom, Karen, tells the admitting nurse
that she found her son, slumped over in his bed, unresponsive. He had been acting funny over the last the
few days. You see, CW had just graduated college 2 months
ago. He got a degree in engineering, but from a
minor midwestern state school. The year was 2011. The US was just coming out of recession. The banks had gotten bailed out, again. Whatever wealth was left, was concentrating
on the coasts. And the effects on recent college grads in
2011 in this region were clear: no new engineering projects were to open in decrepit fly-over
country. As the economy tumbled, CW started reading
about a new project called Bitcoin. At first, he wasn’t sure what it was all
about. Paper money and fiat currency bad, he was
told. At the time, he couldn’t take it too seriously. But he could run the program on his computer. It would do math problems and confirm Bitcoin
transactions, and he would get new coins every day just from doing this. At first he did this for gags and laughs. Just the year before in 2010, someone sold
10,000 Bitcoins for 50 dollars, and another person paid 10,000 Bitcoins for 2 pizzas,
but just year later, 1 coin became worth twenty US dollars. CW couldn’t get a job after graduating college,
but maybe he didn’t need one. He already had thousands of bitcoins. And if the price kept increasing, all of this
would be more money than he’d get as an engineer. He mined as much Bitcoin as he could. He built more computers with the fanciest
graphics cards he could get. The more computers running Bitcoin, the more
coins he could mine. The more he could overclock his graphics cards,
the more coins he could mine. And the more coins he could mine, the more
money he’d make. He became obsessed. As the summer continued, a heat wave started
going through city. At first, CW procrastinated in installing air conditioning. His parents’ house didn’t have central air, so they had to install window units every year. But things seemed ok. CW would sit in his room in a tank top, with
fans blowing everywhere. His rigs were running hot but no problem,
he was making good money. One day, his room was over a hundred and ten
degrees fahrenheit (43.3 C) Usually CW would feel exhausted and tired
in summertime, so this wasn’t out of the ordinary. One morning, CW woke up nauseous. He got out of bed, and instantly felt dizzy. It was hard sleeping the last few days with
his Bitcoin rigs running loud and hot all throughout the night. As the day passed, CW couldn’t eat or drink
anything because he’d feel like throwing it up. And without water, he developed a massive
headache and could feel his eyes pushing out of his skull. He went to bed early, but in the morning,
he didn’t wake up. Karen thought something was wrong when she
hadn’t seen her son all day. As she goes into his room, she instantly felt
the heat. She sees her son slouched over on his bed,
unresponsive, as she calls for 911 and he’s brought to the emergency room where we are
now. Given this history of present illness, doctors
have a few clues as to what’s happening. At examination, CW had tachycardia. Tachy meaning fast and cardia referring to
heart rate. His heart rate was fast, his breathing rate
was fast, but his blood pressure was low. His skin was hot and dry to the touch, and
his temperature measured 106 degrees F (41.1C). You want to be under 100 degrees (F), meaning
that something terrible is happening in his body at the moment, which give doctors the
first clue. CW’s belly was swollen, and a blood test
finds that all of his organs, have started shutting down. Enzymes from the liver were found floating
around in his blood. If the liver is supposed to break down chemicals
in your body, and it does that breakdown with enzymes, then the reason those enzymes are
floating around in his blood, is because his liver cells have started dying, they’re
spilling those enzymes into his body, as his liver shuts down. Waste products that are usually filtered by
the kidneys, one called creatinine, which comes from creatine used by muscles, was present
in blood at a level 3 times higher than normal. Nitrogens were found too. If they’re high in the blood, then the kidneys
aren’t filtering them. Usually, nitrogen and creatinine have a ratio. When the ratio is high, that could mean someone’s
dehydrated. CW didn’t drink much water over the last
few days since he started feeling dizzy and nauseous, so he was dehydrated. But he wasn’t conscious to tell anyone this. And this high ratio gives doctors some more
clues as to what’s happening. If CW is dehydrated and his body temperature
is too high, then all of his problems might just be because of heatstroke. But, how long has this been happening? It’s not good that he’s unconscious, because
it means not only have his body organs have shut down, but that his brain has shut down
too. Medical staff try to cool him down, because
if they don’t, his organs will continue to fail. They submerge his body in ice packs, as they
try to figure out why his body temperature is so high. CW is only 23 years old. Usually, hyperthermia in a young man can come
from overexertion. Working out too hard during a hot and humid
heatwave can impair the body’s ability to waste heat through sweat. If the air is already saturated with water
because of humidity, there won’t be a meaningful release of heat from the body through sweat. This can raise the core temperature. But CW wasn’t exercising; he was found unconscious
in his bed. How about stimulants? Those can increase body temperature. His mom Karen wouldn’t know if he had taken
anything either. But, he didn’t have a history of use and
the toxicology screen came back negative for everything, meaning CW really did heat stroke
in his sleep, because his overclocked graphics cards that were mining Bitcoin were generating
so much heat in his room, during a heat wave, and wouldn’t allow his body to dissipate
heat. But, wouldn’t his body have told him that
things were too hot? Would’t he have just woken up and gotten
out of bed like most people? Not necessarily. CW was dehydrated, but he lost that water
in the days leading up to his heatstroke. Heatwaves don’t just last for one day, they’re
several days long. He hung around in his room with his overclocked
computers mining Bitcoin. He lost water while sweating in his tank top
playing games. He lost water while breathing. And because he was dehydrated when he presented
to the emergency room, it means he didn’t drinking enough water to make up for the loss. Do you remember that CW’s skin was dry and
hot to the touch? Well, it’s hard to sweat if you’re dehydrated,
which is probably why he’s dry. His heart starts to beat faster and harder
to surface blood to his skin to dissipate the heat that should have been lost using
sweat. Less blood goes to the organs, causing something
called ischemia. Isch from an Ancient Greek word meaning to
hold back and emia meaning presence of blood. A holding back of blood to the organs as blood
pressure starts to drop because blood vessels expand to try to get rid of that heat. To make up for this and to keep pressure up,
the heart tries to beat faster and harder, but it’s not enough. His core body temperature goes up again. Enzymes start to denature because of the heat. It’s like these eggs getting cooked as the
proteins start to unravel. The body needs those enzymes to break down
food, to break down nutrients, to function normally, but they don’t work anymore. His organs aren’t getting blood flow anymore,
so they’re getting starved of oxygen. The kidneys can’t filter anything anymore. The liver starts leaking enzymes. The brain tries to compensate for the excess
heat and decreased blood flow by opening up its blood-brain barrier. This leaks proteins in to the brain. But that’s not the only thing going in. As those proteins flow in, water follows too,
swelling in to the brain. This explains CW’s headache. As the water presses in, it explains why he
felt like his eyes were pushing out of his skull. All of this would be ok, except the brain
is enclosed inside a hard space, the skull. As the water keeps following the proteins
in, the brain swells to a point where it crushes up against the skull. As the medical team checks up on CW, he’s
starting to cool off. But he’s not responsive. Acids are found floating around in his blood,
even after aggressive cooling. Even after trying to give him fluids. And he’s transferred in to the intensive
care unit. When he presented to the emergency room, doctors
noticed that CW’s abdomen was swollen. An abdominal X-ray found that parts of his
bowels were dilated. This could mean that something’s blocking
it. It could be a big deal, but maybe not. So doctors thought to wait on it. Over the next 2 days, CW stabilized. His body temperature corrected. His kidneys started functioning again. And things were looking good. Until the third day of admission. At morning rounds, doctors found that CW suddenly
developed a fever overnight. His heart rate was high again, and his blood
pressure was low again. Physical exam revealed that CW’s abdomen
was still swollen. Another X-ray showed that something was causing
his bowels to be dilated. A CT scan showed that the walls of his small
and large intestines have thickened, meaning that parts of his guts are no longer alive. But it’s not the only thing they found. Scattered fluid and free air had accumulated
outside his intestines, into the space where his liver sits. Meaning that not only are parts of his bowels
not alive anymore, but that a hole was perforated into his guts, and the contents were leaking
into his abdomen. But if he was dehydrated and heat stroked,
and his body became like a furnace to shut down his organs, how did it pop a hole in
his intestines? Well, this brings us back to ischemia. Without enough blood going to his intestines
because he’s dehydrated and because his blood pressure is so low, his guts have to
adapt. Usually, they can survive this, but this increased
stress means mitochondria in the cells have less oxygen to work with. Instead of being the powerhouse of the cell,
they start to make reactive oxygen species instead. Nitric oxide, like what you’d find in some
workout supplements designed to dilate your blood vessels, is generated in the intestines,
dilating the colon. The walls of the bowels start to stretch,
allowing bacteria to escape, causing endotoxemia. Endo meaning from within. Tox referring to toxins. And Emia meaning presence in blood. Toxins, from the gut, inside the body, floating
around in the blood. Extra insults where the leakage was happening,
build up as the gut keeps swelling, until a hole pops in the intestines. CW was immediately sent in for surgery to
see what was happening. Surgeons found perforations in his large intestines. What was supposed to be moving through those
intestines, had leaked into his abdomen. An infective coating was found, lining his
intestines, along with dead tissue. Surgeons had to remove parts of his bowel,
and sew together the remaining parts. After surgery, in the recovery room. CW’s condition starts to stabilize. No more liver enzymes are found in his blood. His kidney function returns to normal. His blood pressure and heart rate are just
fine. As he seems to make a recovery. He regains consciousness. But at examination, doctors find mild motor
dysfunction, meaning he has some trouble controlling movements. Several months later, at follow up, doctors
find that parts of CW’s brain that control movement, have atrophied, meaning they’ve
started to shrink, as is common in heat stroke cases where the person wasn’t cooled down
in time, just like CW. Although his brain damage was mild, it is
permanent, as he vowed to never mine another Bitcoin ever again. Personal details of the case from my own experiences
in 2009 and clinical details of CW’s heatstroke case as one I remember from 2012 Chicago. Heatstroke is serious, and sometimes you don’t
realize it’s happening because your body has adapted to the environment you’ve been
in, regardless of your age. So stay well hydrated in the summer time. Stay in the shade, and keep your body cool. Take care of yourself. Thanks so much for watching. And be well.
