A Man Took 1176 Ibuprofen Tablets In A Month. This Is What Happened To His Kidneys. SB is a 34 year old man, presenting to the
emergency room with dizziness, muscle aches, and fatigue. He tells the admitting nurse that over the
last few days, when he would use the bathroom, he’d glance back into the toilet, and it
would look like asphalt. SB loved running, but sometimes his body would
just hurt. Must be getting too old, he thought. One day, while he was running he felt like
his shin splints had returned. It hurt to put any pressure on his legs. Ibuprofen was always his go to when he thought
he was sick or in pain. It’s over the counter. People take aspirin every day and it’s basically
the same medicine, it even comes in 1000 tablet packs. Clearly, you’re supposed to finish the whole
pack of medicine for a full course, otherwise why would they sell it like this? he thought,
as he followed the label and took 6 tablets every 24 hours with an extra one just for
good measure. At first, he would spread out the doses like
the bottle said, but eventually, that was too cumbersome, so he’d take all 7 tablets
at once. And nothing bad happened. He felt great. He wasn’t sure if his legs actually hurt
anymore, but gotta finish that whole course, he thought. One night, SB had forgotten he had taken 7
ibuprofen in the morning. He had also forgotten he took another 7 at
lunch time. And he forgotten he had taken 7 at dinner,
as he put another 7 tablets into his mouth, for a total of 28 in a single day. As he swallowed, he felt that THESE tablets
didn’t go all the way down. It felt like they were somehow stuck in his
chest. This isn’t something to worry about, it’ll
all take care of itself, he thought, as he went to bed. But a few hours later at 3am, SB jumped awake. Just under his chest was a terrible feeling,
like a sharp object had plunged in and started twisting. He wasn’t sure if it was heartburn, but
as the night continued, it did start to go away. When he woke up, he wasn't sure if he was
alright, but Ibuprofen is a pain reliever and he had pain during the night, so the
answer here was to take more. "How does ibuprofen know where the pain is?" he thought, as he went on like this for several
days, consuming all 1000 tablets, and then he bought more. But then SB noticed that he had difficulty
swallowing. It felt like something was in his chest but
he didn't know what. He noticed that his stools were darker than normal, almost looking like asphalt. His stomach would start to hurt like it did
that night. He'd burp, and it’d hurt and taste like
blood. One morning, SB felt especially weak. He thought it was kind of weird how every
time he went to urinate, the volume was so much less than the amount of liquid he drank. He felt like he had the flu, but he checked
and he didn't have a fever. As he stumbled into the bathroom, he looked
in the mirror. He knew he was supposed to be looking at himself,
but something didn’t look right. And as he burped, what came up was blood,
as he calls for 911 and he’s brought to the emergency room where we are now. At examination, there were several clues to
tell the medical team what was happening, because they had no idea of SB’s
ibuprofen excess. He didn't tell them about it because he didn't
think it was a problem. SB’s skin was pale and he had tachycardia. Tachy- meaning fast and cardia referring to
heart rate. His heart rate was fast, but he also had orthostatic
hypotension. Ortho from Ancient Greek referring to straight
or upright. Static also from Ancient Greek meaning fixed
in place but in this context referring to standing. Hypo meaning low and tension referring to
blood pressure. His blood pressure would suddenly decrease
when he stood up. But why was this happening? SB told them about his hematemesis. That his stools looked like asphalt. Both of these suggest that blood somehow got
in to his GI tract and was digested. His hemodynamic instability appears to be
consistent with blood loss-- his tachycardia was his heart beating faster to compensate
for less blood volume. And when he stood up, there just wasn’t
enough blood volume to keep his pressure normal. Clearly, SB has been suffering from blood
loss due to a GI bleed, but why was this happening? This brings us to a concept called dissolution. When you take a tablet or capsule by mouth,
it has to get into the stomach so it can dissolve and absorb into the bloodstream. Do you remember that SB took some tablets
and felt like they didn't go down all the way? Well, sometimes, solid medicines taken by
mouth go into the esophagus, and they just stay there. Most of the time this shouldn’t be a problem. The smooth muscle will get it down by a movement
called peristalsis and tablets and capsules usually slide down when wet. Labels will often say take with a whole glass
of water so you can wash it down, or that you should take the medicine with food, something
that will push it into the stomach, but SB didn’t do that. He went right to bed, and laid down. The tablets that he swallowed that night stuck
against his esophageal mucosa and made contact for some time. But that’s only the start of his problems. Ibuprofen is a Non-steroidal anti-inflammatory
medicine. Some times, the "steroid" name confuses people
because it makes us think of ANABOLIC steroids in bodybuilding and sports. Much more commonly in medicine, we use corticosteroids
as an anti-inflammatory. Inflammation is the immune system response
to physical injury and infection to protect the body, but sometimes inflammation goes
too far. It causes swelling when you don’t want swelling. It causes fever, when you don’t want fever
like for young children where high body temperatures can impact their brain. And inflammation can cause pain, so anti-inflammatory
medicines stop all these from happening. Corticosteroids are based off of cortisol,
which is a hormone naturally produced in our bodies to limit inflammation. Whenever you see a mention of hormones, know
that they are chemical messengers in the body and that they’re subject to natural feedback
mechanisms in order to limit their function and maintain balance in the body. Hormone feedback can be exceptionally difficult
to manage, but ibuprofen is non-steroidal. It works in an entirely different way, which
is a benefit at therapeutic doses. But SB didn't take a therapeutic dose, he
repeatedly took a toxic one over a month and this starts to explain all of his problems. Doctors send a camera down his throat to take
a look at his GI tract, and they find ulcers in his esophagus and his stomach. These look like the canker sores in your mouth
you sometimes get, except for SB, doctors noticed that his ulcers were bleeding. They found the source of his blood loss, but
why is this happening? This brings us back to the name "non-steroidal
anti inflammatory medicine." Steroids work very generally in humans, sending
signals right to the immune system. But NSAIDS like ibuprofen, work very specifically. Inside almost every cell in the body is the
enzyme cyclo-oxygenase. When you get tissue damage like a cut, cyclo-oxygenase
makes a chemical called prostaglandin, and that draws the immune system in. Ibuprofen stops cyclooxygenase from working,
so prostaglandin isn’t produced, and the immune system doesn’t react. This should be ok, except prostaglandin does
more than just draw the immune system in. In the GI tract, it helps inhibit stomach
acid secretion. It stimulates mucus production, and helps
with blood flow in the inner lining. This explains why SB has ulcers, and why they’re
bleeding, because not only was ibuprofen physically stuck to the inner lining of his esophagus
during that one night, he had also been taking huge amounts of ibuprofen for so many days
that there were no prostaglandins, and other ulcers formed, and worsened, and started to
bleed. While the doctors had the camera down SB’s
throat, they were able to stop the bleed by cauterizing the ulcers, that’s applying
temperature to seal the wounds so that they wouldn’t bleed anymore. But this wasn’t his only problem. When he presented to the emergency room, SB
told the medical team that he was noticeably urinating a lot less than normal. When he was admitted, a blood test found that
his kidneys weren’t functioning properly, and when his ulcers were cauterized, another
blood test finds that his kidneys have completely shut down. But this shouldn’t be surprising, bringing
us back to prostaglandins. We already established that prostaglandins
promote inflammation and pain. We also know that prostaglandins help secrete
the protective layer in the GI tract. In the kidneys, prostaglandins open up blood
vessels flowing in. Because prostaglandins aren’t made anymore
for SB due to his mass ingestion of ibuprofen, blood cant get in to be filtered. Blood also can’t get in to supply oxygen. As SB’s kidneys become starved of oxygen,
parts of both start to necrose. And this had been going on for at least a
few days before he presented to the emergency room because of the sheer amount of ibuprofen
that he was taking daily. Do you remember SB thought that his ibuprofen
was just like taking daily aspirin? Well, he was right in that they’re both
NSAIDS. But, daily aspirin is 25% of a full dose of
aspirin, whereas SB was taking overdose amounts of ibuprofen every day. The dose makes the poison, but there’s also
the element of time. Ibuprofen tablets take about 2 hours to go
from the stomach into the blood. This brings us to an idea called half life. When medicine is circulating in the body,
some of it makes its way into the liver, where it’s broken down or metabolized. Half life is the amount of time it takes for
the drug level in blood to be cut in half, and for ibuprofen, it’s 2 hours. Because he took 7 tablets 4 times every day,
the ibuprofen levels in his blood remained abnormally high for a very long time. It caused injury to the point of bleeding
inside his stomach and his esophagus. The blood loss caused his heart to become
unstable. It constricted blood vessels going in to his
kidneys, preventing them from functioning and causing parts of them to start to die. This almost never happens at regular doses. Over the counter medicines can be dangerous
when misused like this. It doesn’t help that some of these medicines
are sold in large bulk packaging, occasionally being misinterpreted by people as designed
for a single course of medicine. The label on the package will always tell
you how to take it. When used properly, NSAIDS are effective antiinflammatories. Ibuprofen is generally more effective as an
analgesic, an meaning without and -algesia referring to pain, compared to aspirin. Blood clotting is a kind of inflammation and
platelets are a kind of blood cell that are responsible for clotting, and they also have
cyclooxygenase. Aspirin is better at working with clots than
ibuprofen because it irreversibly stops platelet cyclooxygenase, unlike ibuprofen which is
reversible, so not as effective. The GI side effects of NSAIDS are so well
known that you find things like enteric coated aspirin, which helps limit contact with stomach
and esophageal mucosa, and also liquid gel caps, which don’t need time for dissolution
in the stomach, they can dump a liquid bolus, quickly absorbed. And generally these medicines aren’t as
common for fever because of their known GI and kidney side effects, for fever, you usually
take acetaminophen [paracetamol], which can still be misused, but has a high therapeutic
index. This brings us to another concept called drug
resistance. Sometimes you’re told if you take ibuprofen
for headache too often, it will eventually just not work for you anymore. That’s not true. It’s not an antibiotic where you’re pitting
drug therapy against a live organism and the organism evolves to evade the medicine. It’s also not a habit forming medicine based off of this plant, which can create a dependency based on the body adapting to it. If you’re taking NSAID for pain spread out
through a couple times a month, theres no rebound feedback mechanism, or adaptation
in the body that will limit its efficacy. I had to explain that to my own parents, because
they used to scare me out of taking headache medicine when I was a kid. And the topic of NSAIDS can go on forever. In the context of cyclooxygenase, theres
multiple isoforms of it, and we’ve found medicines that inhibit only COX-2 instead
of COX-1 for pain, and interestingly enough one of them is named “celecoxib,” “selective
COX inhibitor,” and it’s analgesic without prominent GI side effects bringing us back
to SB. In the hospital, the medical team infused
water through his body to rehydrate him and to get flow back through his kidneys. His bleeding ulcers were fixed, and the waste
that was floating around in his blood because his kidneys had shut down was managed. Without knowing his baseline kidney function
before he took all the ibuprofen, it’s not known by how much exactly his kidney function
decreased, or how permanent any damage done might be. But when the time arrived, massive urination
preceded him being discharged from the hospital, as he was able to make a recovery. This case was referred to me from a Chinese
question and answer website, asking if ibuprofen really does come in 1000 tablet packs in the
United States. Every situation described in this video is
one that I have seen myself, relating to NSAID misuse, which unfortunately is common. There’s other situations I didn't describe
here, like patients taking multiple prescription NSAIDs because they saw different primary
care, and no one knows that the patient is doubling up or tripling up their care. So please do your best to be aware of what
medicines you’re taking, how much you’re taking, and how often you’re taking them
and please try to stick with the instructions that are on the package label. Thanks so much for watching. Take care of yourself and be well.
i made it 2 minutes in, and I had to stop. Some of the Div 1 swimmers I swam with would down 20+ before races to stop the lactic acid pain. 🤢🤢🤢
Too close to home with that one.
He must have ran out halfway between town stops
That's 40 a day.
His Vitamin I levels were off the charts!
Thought you were gonna say the predator was hunting ULers with that pic
Leave me alone!!
Bruh, I don't have time to watch that video when I'm trying to get FKT across my backyard.