A Dad Mistakenly Drank A Lava Lamp Before
Bedtime. This Is What Happened To His Kidneys. AW is a 35 year old man, presenting to the
emergency room with nausea, tremors, and altered mental status. His wife Sheila, is in a panic because her
husband had at least 4 seizures in the last 15 minutes. AW was a dad who had a problem. For several years, he just couldnât get
enough from the bottle, until one day, he hurt his family in a haze and vowed to never
drink ever again. Days after his last drink, AW began shaking. A tingling pricked into his fingertips. Little bugs were crawling underneath his skin. He was sweating but was shivering cold. He was tired, but couldnât sleep. He had intense cravings, and no access to
drink. In bed now, delirious, AW saw the glowing
lava lamp on his night stand. There must be some nice drink inside, he thought. A little sip of it would cure all his problems,
he thought. Immediately after one-shotting the entire
lava lamp, AW started rolling on the floor. He clenched parts of his bed frame, as his
stomach curled in his body. This feels better already, he thought. As the night continued, AW became more delirious
as he found himself huddled over the toilet. Itâs morning now and Sheila finds her husband
on the bathroom floor, seizing non-stop. She calls for 911. In the ambulance, paramedics see him suffer
yet another seizure as heâs brought to the emergency room where we are now. Given this history of present illness, thereâs
several clues as to whatâs happening. Sheila tells the admitting nurse that her
husband stopped drinking cold turkey, but doesnât tell the nurse that he mistakenly
drank a lava lamp the night before. As his seizures recur, each successive one
becomes longer and more intense. This makes sense because alcohol, or more
formally ethanol, depresses the central nervous system. Years of over consumption cause the brain
to adapt to its presence in blood, so suddenly taking it away can cause brain problems, which
brings us to the first clue. The seizures. The shaking. The bugs underneath his skin. This is clearly a case of severe alcohol withdrawal. As the medical team continues their assessment,
AWâs convulsions develop into status epilepticus, a life threatening electrical discharge of
brain lasting longer than 5 minutes. He no longer regains consciousness in-between
his seizures. This immediately increases his chances of
death. As nurses scramble to terminate his seizures,
11 syringes of the sedative lorazepam were injected to finally shut down his seizures
for the moment. Conscious again now, AW is still incoherent. He clenches his sides in pain, and a blood
test reveals that he has hypocalcemia. Hypo meaning low Calce referring to calcium And emia meaning presence in blood. Low calcium presence in blood. Because muscles need calcium to commit to
a contraction and his calcium levels in blood are low, then he should have muscle problems
like a twitching. But he doesnât. This absence of that twitching could mean
that he has acidemia, an acid presence of blood. When the blood is more acidic, it subtly reshapes
the proteins by allowing them to bind less ionized calcium, preventing tetany, or twitching. But if he has acid floating around in his
blood, and the kidneys are supposed to be removing this acid, well this brings us to
the next clue. Urine analysis now confirms that AW is not
only dehydrated and acidotic, but that he also has something called prerenal azotemia. Azote an old term referring to nitrogen. Emia again meaning presence in blood. A nitrogen presence in blood. Pre renal meaning there is something wrong
in his body thatâs preventing blood flow to the kidneys. The medical team realizes that this is not
simply a case of alcohol withdrawal. Clearly, something else is wrong and Sheila,
stays quiet as her husband lies in delirium. Bacteria, was found in his urine meaning he
has an infection somewhere along his urinary tract. Because AW is a man, and men have longer urinary
tracts than women, and longer tracts are less likely to be infected, then it means when
there is an infection, itâs a big deal and it could mean bacterial growth all the way
up from his kidneys, which could explain the nitrogen. As AW is started on antibiotics, his urine
output dramatically declines to the point of zero. Acid and waste build up in his blood. His breaths become more distressed. His psychoactive disturbances more active. At several hours after initially presenting
to the emergency room, AWâs body goes into multi organ failure. And itâs here that Sheila finally tells
the medical team, about the lava lamp that her husband drank before bedtime. Laboratory tests were done on left over parts
from AWâs lava lamp. Wax, kerosene and polyethylene glycol were
found, all dissolved in water. Wax is in general non toxic in humans. Kerosene, at least in the amount that could
be found in a lava lamp is not poisonous, but the polyethylene glycol, could be a problem. Ethylene glycol is antifreeze. The eth- prefix means 2 carbons. Glycol is an old name for glycerin now referring
to these 2 alcohol groups. Poly means more than 1 ethylene glycol chained
together, but exactly, how many more? If itâs poly as in 75, then whatâs antifreeze
as a singular molecule becomes a commonly used laxative when chained together, 75
times. Because oxygens interact with hydrogens on
water, it draws fluid into the bowel, softening the stool, inducing a stretch reflex on the
smooth muscle of the GI tract and promotes movement. But if poly means less than 10 ethylene glycols
chained together, well, thatâs toxic and this low molecular weight polyethylene glycol,
is whatâs found in AWâs lava lamp. Do you remember the formal name for alcohol? Well, ethanol has that same eth prefix. The molecular structure looks a lot like ethylene
glycol. In the body, ethanol is metabolized, or broken
down by the liver into acetate, which is one half of vinegar, and the body does this so
the molecule more easily dissolves in water, so it can concentrate in the urine, and be
excreted from the body. 3,000 ethylene glycols chained together is
too big to fit in the enzyme, so that passes through as a laxative, but when poly means
less than 10 ethylene glycols, well these are small enough to fit into the enzyme to
produce oxalate, which is more water soluble so fine the bodyâs doing its job, but when
oxalate touches calcium in the blood, it reacts. And if AW is hypocalcemic, then we know now
where that calcium is going. The problem is that Calcium Oxalate doesnât
dissolve in water. It becomes a solid. Itâs another name for a kidney stone. So as more and more calcium in AWâs blood
is depleted by reacting with oxalate, solid crystals deposit in his tissues, blocking
blood flow and causing multi organ failure. As these crystals creep towards his kidneys,
flow becomes blocked as they accumulate in his tubules, killing them, causing prerenal
azotemia and causing parts of his kidneys to necrose or quite literally die. This damage may be irreversible and If nothing
is done to address this, AW will continue to swim in a pool of his own bodily waste. The idea of clinical decline complicated by
an incomplete patient history has always been a problem in medical practice. An elderly man got syphilis when he was young
and it was dormant for decades. He presented to the emergency room one day
with declining mental status and was found to have neurosyphilis where the bacteria entered
his brain. He was treated with antibiotics and discharged
days later, but with minimal improvements in mental status. A poorly gathered medical history neglected
that he also had previous autoimmune disease where his immune system attacked his organs,
including a part of his stomach that secretes proteins enabling his body to absorb vitamin
B 12. Without vitamin B 12, the dorsal, or backside,
and lateral, or away from the median, columns of the spinal cord begin to demyelinate. The resulting neuropsychiatric changes from
the lack of B 12 looked like the ones caused by neurosyphilis and was neglected by the
medical team. The subsequent autoimmunity was not caught
until it was too late, where thyroiditis and pancreatitis leading to type 1 diabetes had
settled in, both permanent and irreversible problems, all from an uncoordinated gathering
of past medical history. In a woman who had cancer, immunotherapy was
given, meaning her immune system was unleashed by medicines, allowing her own cells to attack
the tumor. She had a complete response and was able to
eliminate her cancer because of the medicine, but several months later, began experiencing
delusions that developed into a psychosis. She had to be admitted into a psychiatric
ward due to hallucinations, cognitive impairment and disorganized speech. She was diagnosed with schizophrenia and given
medicines to control her negative symptoms but with little improvement. It wasnât until a chance endoscopy discovered
that she had celiac disease, where a gluten allergy inflamed her bowels, that may have
come from the unleashed immune system that not only attacked the cancer cells, but also
attacked her gastric parietal cells. The presence of gluten in her diet unleashed
delusions and caused her cognitive impairment as an effect of celiac disease. And without a detailed history and knowledge
of adverse events from previous treatments, she was misdiagnosed with refractory schizophrenia
when it was really a neuropsychiatric manifestation of a gluten allergy. In AW, If anything can be done, we can first
rehydrate him with IV fluids. Since his kidneys arenât working, we can
divert his blood into a machine and filter it through there, a process called dialysis. But this doesnât clear out the kidney stones. It doesnât reverse the renal tubular necrosis
and bring parts of his kidneys back to life. And it doesnât stop any more oxalate from
being made from the lava lamp liquid that AW drank. Which brings us to the final complication
of this case. Ethylene glycol and ethanol are metabolized
by the same enzyme. In humans, that enzyme binds stronger to ethanol,
meaning if we let AW drink again, we can stop the formation of oxalate and depletion of
calcium. But, if we let him drink again, hes going
to relapse again, heâs going to go into withdrawal again at a later time, and it negates
the initial reason why he thought to drink the lava lamp in the first place. Thereâs one final point to think about here. Do you remember the lorazepam used to terminate
AWâs status epilepticus? Well, lorazepam is a solid that doesnât
dissolve in water, so itâs formulated with a solvent known as low molecular weight polyethylene
glycol, meaning that his seizures from ethanol withdrawal prompted termination by a medicine
containing the same compound that was poisonous in the lava lamp he drank, feed the process
forward as calcium oxalate crystals deposited, and shut down his kidneys. At the point where status epilepticus emerged,
it wasnât clear to the medical team that AW drank a lava lamp, and it wasnât clear
that low molecular weight polyethylene glycol was the kidney toxin contained within in,
and stopping his seizures took first priority. Some patients with severe alcohol withdrawal
may be hospitalized for several days, and given high doses of lorazepam, per hour. If theyâre put on nephrotoxic antibiotics
during their stay, like AW was, then this alone, could cause kidney damage. 11 syringes worth of lorazepam likely pales
in comparison to drinking a lava lamp but subsequent doses for preventing ongoing seizures
may be significant. But there isnât another anticonvulsant that
doesnât have some form of alcoholic solvent, so there wasnât a better alternative. There was no easy answer to treating AW, because
his underlying issues, simply werenât easy. With a long hospital stay and supportive care
from the medical team, AW sustained a recovery. Thank you so much for watching. Take care of yourself. And be well.
What's "A" recovery?
I don't believe it's possible to accidentally drink a lava lamp.
How the fuck do you slam a whole lava lamp? If it's glowing, it means it's hot, like really fucking hot. Just brushing against it is enough to burn your skin almost right away once it's to the point the wax is melted.
Why didnt his wife let them know he drank the GOD DAMN LAVA LAMP. She probably wanted him dead.