Hi everyone, Dr Bernard here. This is medicine. It’s for muscle aches and pains, and you
apply it to the skin. There’s a label on the box that’s required
by law here in the United States, and it tells you how to take it. It says apply to affected area. If the area’s not affected, might not wanna
apply it there, just like this patient will find out. I make a new video every month, so if you
hit subscribe and the bell to get notifications, we can read all the references to subject
matter and related cases linked in the description below, together. A boy rubbed an entire tube of pain relief
cream on all the parts in-between his legs. This is what happened to his brain. CG is a 16 year old boy, presenting to the
emergency room with abdominal pain, headache and polyuria. Poly meaning many and uria referring to urine. He was urinating excessively. Earlier the day before, CG was with his friends. They liked to make fun of where they lived,
it’s a boring place, nothing ever happens. But this time, they were going to make something
happen. One of the friends, Jake, had recently strained
his neck when he slept funny one night. Looking for some kind of therapy, Jake found
pain relief cream. He heard it had some medicine in it. But it’s also minty, you’ll feel a burn,
you’ll focus on that burn and you wont feel the pain anymore. Jake, applied some of this cream on his neck
and then right after, he had to use the bathroom. The hand that applied the cream, made contact
with all the parts in between his legs. Immediately after putting his pants back on,
Jake could feel his groin go from ice cold to burning hot as he spent the next 30 minutes
in world of hurt to the point where he felt nauseous. “If there’s a way to get someone to rub
a whole tube of this cream in between their legs, it’ll be the funniest thing I’ll
ever see,” he thought. One day, while everyone was hanging out, Jake
ate a piece of 3 week old pizza, and that pizza came right back up. As the friends laughed in his face, he felt
embarrassed but then seized the opportunity. He challenged them— eat a piece of the pizza
or rub a tube of this pain relief cream in-between your legs. One or the other, otherwise you’re not leaving
my house. Clearly this was a nonsense game played by
a group of bored teenagers, but they were determined. One of the friends, ate the pizza while the
others watched, and that pizza came right back up. Pain relief cream is just minty lotion, the
other friends said, they use it in hospitals all the time so it’s safe for everyone,
as CG opened the tube. Immediately after slathering a handful of
the cream on all the parts in-between his legs, CG wasn’t sure what he was feeling. It felt cold, not really that uncomfortable
at first, but then the burn started to settle in. As the minutes passed, he felt like someone
had put a blow torch to his groin and started searing it like a steak. As the pain intensified, he started to panic. The friends said that even more cream will
help neutralize it because if there’s too much cream in the area, none of it can absorb
into the skin so this is totally like an antidote to itself. But then the hurt got worse as he rubbed the
rest of the tube in. As CG tried to wash it off, it burned even
more. Everything was red and irritated, he felt
like there was a chemical burn on his groin feeding in to his rear. As the hour continued, the pain started to
fade. At first, it seemed like everything was over. But then CG started to feel like the air coming
out of his nose was hotter than normal. He laid down on the floor, and everyone noticed
that he was gasping for air. He didnt realize he was breathing this way
because when someone asked, he had no idea he was doing it. As the hours pass, a high pitched ringing
started playing in his ears that wouldn’t go away, and the music the friends were playing
in the house started shifting in pitch. His chest was pounding, his arms and legs
felt weak. He would urinate every couple minutes like
he had chugged gallons of water, but he didnt drink anything. When he went into the bathroom to empty his
stomach, the friends thought something was wrong. CG didnt eat the pizza. But as they find him laying down in a crooked
and twisted position on the floor, they call for 911, and he’s brought to the emergency
room, where we are now. Bengay Ultra Strength is a mixture of camphor
and menthol, both of which are responsible for the cool, then warm sensation when applied
topically, but this formulation also has 30% methyl salicylate. This is related to aspirin, known as acetylsalicylic
acid, which in the body, they both become the same salicylate. This anti-inflammatory is the reason why it’s
in the cream, for pain. These derivatives are some of the most common
over the counter medicines. Pepto Bismol for stomach ailments is bismuth
subsalicylate and even some face washes have salicylic acid. And it’s the salicylate causing all of CG’s
problems, but the medical team dont know that. Hes too embarrassed to tell anyone what he
did. This probably will pass on its own, he thought,
so he just tells the doctors that he hasn’t been feeling well. At examination, doctors noticed CG was responsive,
so nothing was wrong with his brain. At least not yet. His breathing and his heart rate were fast,
but his lungs were clear. His fast breathing wasn’t because something
was blocking his airway, and his heart doesnt have any problems. A blood test finds he has hyperglycemia. Hyper meaning high. Glyce from Ancient Greek Glykys referring
to glucose or sugar. And -emia meaning presence in blood. High sugar presence in blood. It wasn’t just a kind-of elevated blood
sugar level, it was so high that doctors presume CG has new onset type 1 diabetes, the type
that’s caused by pancreatic damage, not insulin resistance that can develop later
in life. They presume he’s experiencing an acute
illness because of it called diabetic ketoacidosis, known as DKA. Keto referring to ketone, a chemical that’s
formed in the blood due to the fact that the body has metabolic derangements. Acidosis referring to a disorder in the body
resulting in a flood of acid floating around in the blood. And diabetic meaning that all of this is coming
from a problem of how the body handles and responds to sugar or glucose, bringing us
back to hyperglycemia. Because CG is 16, he’s considered a pediatric
patient. Hypoglycemia this severe doesn’t happen
suddenly, it takes hours to days meaning the body has had some time to adapt in the setting
of DKA. If everything is corrected aggressively and
too quickly, overcoming those adaptations suddenly, could do more harm than good. But, this is a problem because while DKA needs
to be treated slowly in a patient of this age, CG doesnt have DKA. It looks like he does at admission, but he
doesn’t. Salicylate poisoning, which is what he has,
needs to be treated quickly. Precious time can be wasted if the medical
team doesnt find this in time, as they start him on insulin that slowly infuses in to him. Insulin’s a hormone that’s naturally released
in your body after a meal, it gets the body’s cells to absorb the sugar and nutrients from
the blood. It works because his blood sugar becomes normal
again over the next few hours. But the time has been lost now because CG
starts to become confused. He doesn’t look well. The salicylate poisoning from that tube of
cream rubbed in-between his legs is getting worse. Another blood test finds he has low bicarbonate
presence in blood. But what does this mean? Bicarb is a base. It’s one part of baking soda known as sodium
biCARBONATE. When we breathe air in, our body wants the
oxygen from that air, so it can produce energy and function. When we breathe air out, our body puts out
CARBON dioxide. Same CARBON as biCARBONATE. The body wants balance. If he has low base presence in blood, and
the opposite of base is acid, then he should have a lot of acid in his blood. Except, that same blood test finds CG’s
blood is a little more basic than normal. This tells the medical team that something
other than ketoacidosis is happening to CG and they need to figure it out quickly. Skin is not the same across your body. The skin on your palms and on the dorsum,
or backside of your hand are very different. You can feel it. You can see it. Scrotal skin is not at all like the skin on
your hands and arms. It’s thin. There’s an abundant blood supply going right
to this external sac of skin and muscle. Applying a cream that’s meant to absorb
into the area where you apply it, will likely absorb a lot when applied to somewhere thin,
with an abundance of blood vessels, like the scrotum, meaning methyl salicylate applied
here can absorb right in to the blood stream. There’s structures adjacent to the scrotum,
that will likely absorb the cream as well. In a small science experiment, the scrotum
was found to absorb creams rubbed on it at a rate 42 times more than when those same
creams were applied on the forearm. If CG rubbed an entire tube in between his
legs, and that tube is 30% methyl salicylate, it means up to 55 big tablets worth of aspirin
absorbed in to his body. Just 6 big tablets can start to cause problems
in adults. When you take medicine by mouth, it goes into
your gut and then absorbs into your liver where a large percentage of it is immediately
broken down. This is called first pass metabolism, and
explains why medicine taken by mouth sometimes will have higher doses than their intravenous
formulation, because IV goes directly into the blood circumventing that first pass. CG, rubbing Bengay on his scrotum, means the
methyl salicylate absorbed directly into his blood, a large portion of it not getting broken
down by the liver first so the dose is even higher than if it were taken by mouth, as
it starts flowing around his body. This explains all of his problems. Salicylate is a toxin of the mitochondria,
powerhouse of the cell. By disturbing energy production, fats, which
are used to produce that energy, are disturbed in this case, allowing for glucose, which
is also used to make energy, to spill into his blood in huge amounts, to the point where
doctors suspected he was having a diabetic attack, but he just didnt have diabetes. As the energy production is disturbed more
and more by the huge amount of salicylate in his body now, the mitochondria keep working
harder and faster, but nothing gets produced. If nothing is done about this, more and more
salicylate absorbs in to the organs, and there’s no way to pull it out once it’s in. It causes the lungs and the brain to swell
with fluid. Because salicylate absorption isn’t reversible,
the brain will expand and crush up against the sides of the skull causing permanent damage. The fact that hes becoming confused now means
that his brain is starting to be affected. Heat and acid start spilling into his blood,
causing acidosis. His body, tries to compensate for this by
breathing quicker. Carbon dioxide, when it’s in the blood,
increases acid content. Because we breathe out carbon dioxide, breathing
faster and harder will suppress acid levels in the body explaining why his blood was basic
while he had low base presence in blood, but only for a certain amount of time. The medical team, recognizing this blood abnormality,
order some more tests, and they confirm he has high salicylate presence in blood. When they asked him if he had some contact
with some kind of medicine, he was embarrassed and he didn’t want to say. He was partially responsive so he may not
have been able to say, even if he wanted to. But one of his friends blurted out that CG
did in fact, rub a whole tube of Bengay on the parts between his legs. Young men are well known to rub things like
Bengay and Tiger Balm and Icyhot on their scrotum, either as a joke or as a challenge, or just however
young men tend to operate. There’s more recent reports of men applying
it to the region for other purposes. A general rule of thumb, is to not apply anything
to your scrotum if you dont need to. Especially if it contains medicine. Water and soap when you need to wash the area,
is fine. Whether or not this particular pain relief
cream will make you infertile if you’ve done this before, i suspect that’s not likely. There’s people documented to have passed
from doing this. In one prominent case, it was a girl, high
school athlete, who applied copious amounts to a large surface area. From what I understand, she did not apply
it to the equivalent structure in-between her legs, vaginal mucosa is highly vascularized
and is a direct in to the blood stream too, but she applied an amount enough, often enough,
to get high salicylate presence in blood, significant enough to cause the end of her
life. If you are a man or have biological mens parts,
deliberately applying copious amounts of this cream to this area, you are putting yourself
at risk of a poisoning that can become deadly, because of how much can absorb through the
scrotum. This is the kind of poisoning where you can
go to sleep because you’ll be fine for a while, and then suddenly you just won’t
wake up. After days in the hospital, a lesson learned
about not rubbing unreasonably copious amounts of medicine on sensitive parts of the body,
and care from a medical team that was diligent, CG was able to make a full recovery. This video is comprised of parts from 2 different
cases, done this way to teach about salicylate toxicity, mixed acid base disorders, diabetic
ketoacidosis, and dermal absorption of creams and ointments. There appears there could be a rising incidence
of salicylate toxicity from this route of administration for reasons I described earlier. Thanks so much for watching. Take care of yourself. And be well.
Lesson learnt, rub some Bengay, catch the Big GAY