A Girl Ate Leftover Potato Salad for Lunch. This is What Happened To Her Liver. CG is a 17 year old girl, presenting to the
emergency room with a progressive deterioration in balance, gait and speech. She tells the admitting nurse that she felt
a burning in her stomach over the past couple days. She had several stomach movements from one
particular end. You see, CG was an American high school student. On the weekends, she got to stay with her
dad in the city. Over the last couple of months, she started
noticing that she had trouble with balance, writing and speaking. Sometimes she had something to say, but she’d
have trouble getting the words out. One weekend, CG was with her dad. The only food he had in his fridge was homemade
potato salad. He was really proud of this one because he
made all the ingredients from scratch, including a new dill pickle recipe he found on the internet. Before his daughter heated up some leftovers,
he warned her that it was too delicious and that she wouldn’t be able to eat just one
serving. But he also told her that he felt some discomfort
from both ends after eating some a few days earlier. Ignoring both of these warnings, CG heated
up a large bowl of leftover potato salad. She was feeling great after eating it. She went back for seconds. And thirds. As the day continued, CG became incredibly
thirsty. She quickly gulped down 2 whole bottles of
water. Must have had a lot of salt in that potato
salad, she thought as she started doing her homework. Over the next few hours, CG felt a burning
sensation brewing in her stomach. It would come in waves. She didn’t want to complain to her dad about
it, because she didn’t want to hurt his feelings about his cooking. She kept quiet about everything. She saw a rash growing on the dorsum, or backside
of her hands, and decided to go to bed early. The next morning, CG woke up. There was no more rash on her hands, but her
entire body was in a world of hurt. The burning in her stomach was now accompanied
by a sharp prodding feeling in her side. Her joints all felt stiff. When she told her dad about this, he said
“welcome to old age,” as he left to go run some errands. As the day passed, CG found it increasingly
difficult to move. She started noticing that her skin was turning
a greenish yellow. She hiccuped. And then huddled over the sink. Something green came up. This kept happening, every hour. As the week continued, CG had to miss school
because she felt so ill. She couldn’t keep anything down. Every time she had to hiccup, it was followed
by another movement up and out. As she finally couldn’t take it anymore,
her mom called 911 and she’s brought to the emergency room where we are now. At examination, doctors noted that CG’s
stomach was distended, or swollen. She was clearly jaundiced as evidenced by
the yellowing of her skin and the whites of her eyes. Both of these are indicators that whatever’s
wrong with her, is coming from her liver. This gives the medical team some clues as
to what’s happening. CG noted a metallic taste had come up every
time she hiccuped, and as she was telling this to the medical team, she hiccuped again. And things came up again. And doctors saw it first hand. This could be some kind of food poisoning
from the potato salad she ate, except a blood test revealed anemia. An meaning without and emia meaning presence
of blood. There was something wrong with her red blood cells. That’s not something that usually comes
from food poisoning. Lab abnormalities from that blood test confirmed
liver dysfunction (students, can you give 3 examples of what these could be?), bringing
us to the next clue. The liver is important for several things
in the body. For starters, It makes proteins. Some of these proteins are blood clotting
factors, which stop you from bleeding when you get a cut. Other proteins known as albumin hold water
in specific compartments in the body, so that fluid isn’t flowing freely all throughout. And because of how it’s connected to the
small intestines, the liver processes all the nutrients that you put in your body, from
your mouth. This sets the stage for defining CG’s liver
problems because Her blood clotting factors aren't working fast enough (students, how is INR defined?) meaning the liver might
be having trouble making them. And it might be having this trouble because something is preventing it from making those proteins But this measure was still in normal range, even if it was at the upper limit of normal. This could be a problem, maybe not. CG’s abdomen is swollen with fluid, something
called ascites and it means that that albumin isn’t being sufficiently produced by her
liver now. When combined with jaundice and anemia, all of this points to some degree of potential liver injury for CG. But what could be causing this? This brings us back to anemia. CG reported metallic taste in her mouth, and
a green emesis that followed her hiccups. This could be a problem of B vitamins. Both of these are generally greenish yellow
liquids. They’re stored in the liver. And, their deficiencies can cause anemia (students-
macro or microcytic anemia?), but CG didn’t have vitamin B deficiency. She was tested for iron and copper. These are actual metals-- that could be contributing to her metallic taste Iron Deficiency causes anemia. This is because red blood cells hold on to
oxygen using hemoglobin, a protein that contains iron. And for copper, too little and too much, both
cause anemia. And in CG’s case, she has too much copper The medical team finds that she has hypercupremia. Hyper meaning high Cupro from latin Cuprum, which was borrowed
from Greek Κύπρος which is Cyprus in English. The island where western ancients got their
metals from. And emia meaning presence in blood. High copper presence in blood. But where did this copper come from, she ate
potatoes and why is it causing these problems? At this realization, CG’s dad tells the
medical team that he had gotten sick from the potato salad, in a similar fashion, just
not as severe. He recalled that he used a copper pot and
utensils that he bought from an antique store to prepare the pickles he put in that potato
salad. But how does copper from a pot and tongs,
get into pickles? Well, there’s some basic chemistry to be
known here. Copper when exposed to oxygen and moisture
in the air, reacts. This can happen to pots if they’re not coated
well. If it’s antique, there’s a good chance,
then there's a good chance it wasn't coated well (or at all). The moisture from condensation in the pot,
likely reacted with the copper and created something called copper oxide. This is exactly how old pennies got dirty,
because they’re made of copper too. When pickling vegetables, vinegar is used. Vinegar is an acid. Vinegar, reacts with copper oxide, picking
it off the pot, and putting it in the pickles,
and then into the potato salad. In the body, copper disrupts normal functions. Because CG ate it in the potato salad, it
traveled from her stomach, to her liver. And just like how it reacted with oxygen when
it was in the pot, it reacts with oxygen in her liver, creating reactive oxidative species,
that destroy everything. For CG, her mitochondria cannot be the powerhouse
of the cell because this reactive oxygen, disturbs energy production. Disrupting this metabolism, damages the cell. Additional injury is delivered to the DNA,
as CG’s liver cells all start to burst. And as this process happens at a cellular
level, the liver tissue becomes injured, causing problems with her blood clotting factors causing problems with albumin production causing impaired uptake of bilirubin, causing jaundice everything that is happening to CG. If too much copper is her problem, is there
a way we could somehow remove that copper from her body? Maybe. Because copper likes to react with oxygen,
and it does so by pulling electrons away, then we can ask a heavier element, similar
to oxygen, to react with copper instead? On the outside of this molecule, we want it
to dissolve in water, so that it can be removed by the kidneys, and put in the urine. CG was given Penicillamine. Not the antibiotic penicillin. Penicillamine. The sulfur and nitrogen capture the copper,
and the entire complex is filtered by her kidneys, and released in her urine. After 8 days in the hospital, CG was discharged,
as she seemed to make a recovery. More visits with her dad prompted her to never
again, eat any of his cooking, even if he vowed to never use antiques to cook. But as the weeks go by, CG doesn’t seem
to be ok. After discharge from the hospital, that deterioration
in balance, gait and speech she had before eating the potato salad, was getting worse. Even though she never again ate her dad’s
food, her mom started noticing her jaundice again. At school, rumors started going around that
CG was going to have a baby. Her stomach had a bump. She’d be found before class in the bathroom,
huddled over the toilet, with what looked like morning sickness. And during class, she had to leave the room,
because she couldn’t stop sweating. Back in the emergency room again, CG tells
the doctors about a burning in her stomach. She is found to have ataxic gait. A meaning without and taxic meaning order. Gait being her walk. It was awkward, imbalanced, disorderly. This was combined with dystaxic handwriting
and slurred speech, all of which can point to some potential neurodegeneration, not found
when she ate that potato salad. meaning something has been happening since then Jaundice and ascites are found, again. A blood test this time reveals that her clotting
factors, are just not working properly now (students- INR limit for acute liver failure?). They were borderline last time, but it’s
clear now that something’s wrong. Usually, a liver problem on this scale like
this would cause mental status change (hepatic encephalopathy) This is because the liver processes ammonia
that comes from a breakdown of proteins in your GI tract. But if the liver is failing, this ammonia
spills into the body, and goes to the brain. But now the question is, does CG have liver
injury, or liver failure? It’s important to make the distinction because
failure is much more severe than the injury. Jaundice, ascites, and the blood test confirm
something’s wrong with her liver. The clotting factor problem is an emergency
because it can lead to something terrible, if nothing is done about it. In adults, it’s hard to qualify liver failure,
without the mental status change. But CG isn’t an adult. She’s 17. Her motor dysfunctions are not mental status
change. About half of pediatric patients can present
without this, and still have acute liver failure. And in CG, she has acute liver failure. Ultrasound finds that her gallbladder is swollen. Inside, there appears to be a sludge that
has been building up over time. Bile is a fluid made by the liver, and stored
in the gallbladder, that helps the body digest fats. This sludge means that CG’s liver could
be making something, that it shouldn’t be. A calculation is made on her blood test results. With 100% specificity and sensitivity, the
calculation reveals that CG has Wilson’s Disease, a genetic disease that prevents the
liver from eliminating copper from the body. (students, what is this Wilson’s disease
test?). She is immediately transferred to the intensive
care unit, and evaluated for liver transplantation, because what’s left of her current liver,
is beyond repair. This Wilson’s disease is something that
had been brewing for sometime in CG, and was made much worse when she ate that potato salad. In humans, copper has to be shuttled around
by proteins. We’ve already shown how reactive copper
is when alone and flowing freely in the body. But in Wilson’s disease, an inherited genetic
defect prevents the correct production of this protein, meaning its ability to transport
copper is impaired. Causing it to build up. Causing damage to the liver cells by creating
reactive oxidative species. This forms a sludge in the gallbladder as
the acute liver failure in CG causes permanent damage. As the copper spills into the bloodstream,
it enters the brain. In normal function, the same protein as found
in the liver also transports copper out. But because of the genetic defect, that doesn’t
happen. Copper accumulates in the brain, and this
metal toxicity begins to damage nerve cells, permanently. Showing up as motor dysfunction in CG. Copper in Wilson’s Disease often deposits in the eyes as a complex with sulfur, forming a brownish or gray-green ring. This happens often in Wilson’s disease, but not all the time. It can also happen when there’s problems of bile flow from the liver, in patients without Wilson's Disease But in the intensive care unit, the medical team
calculates a score to predict her survival, given the results of her blood test. (King’s criteria btw). A score higher than 11 gives little chance
of survival without liver transplant. And in CG, it’s higher than 11. She is immediately placed, on the liver transplantation
list. Because she was noted to have acute liver
failure instead of injury, her placement is high. Because her life expectancy is less than 7
days because of the extent of her disease, she was placed at the very top of the list. Days pass while she’s in waiting. A donor was finally located. A 19 year old who sustained a head injury
and passed because of shock. CG undergoes transplantation and transferred
to the transplant unit afterwards. She received medicines that suppressed her
immune system, so that it wouldn’t attack her new liver. 10 days after the operation, she was sent
home, and monitored. Her new liver was from a donor who didn’t
have Wilson’s disease. Meaning, those liver cells do not have the
genetic defect that she inherited, and they can make the protein that transports copper,
curing her from the disease. But the DNA in her body, still has those genes. When she has kids, they will at a minimum
be a carrier for the defect, if they don’t have Wilson’s disease themselves. And if they’re carriers, there’s a chance
that CG’s grandkids will be affected in the same way, as she was when she had this
critical illness. But with the new liver, and support from her
family. With a father who learned to never pickle
foods using copper containers, or really, use anything copper at all for cooking, CG
made a good recovery. Thank you so much for watching. Take care of yourself and be well.
I’m eating left over potato salad right now wonder what happens to her
Edit: I don’t feel good
Excuse me. Just one question. Who the fuck heats up potato salad?
tl;dw Don't cook food (especially acidic) in an antique copper pot or one without a proper metal liner to prevent excessive amounts of copper leaching into your food. This can bang up your liver pretty bad.
This is a horrible recommendation for this sub.
Perfect video to watch while eating /s
I thought for sure they where gonna pull some sorta worm out of her stomach. It’s always a worm and I’m always disgusted but I keep watch videos like this.
This is not good to watch while I eat :(
this made my heart beat too fast for a story ab potato salad
Very informative I liked that