Heme Review

Renal Medullary Carcinoma: A Kidney Cancer Associated with Sickle Cell Trait and Disease Aug 18, 2021

Video version of this podcast: https://youtu.be/j7WGP6sJBLk

Chubbyemu video A Man Felt Pain In His Back. This Is What Happened To His Kidney. https://youtu.be/3E75UvmY9GA

References:

Renal medullary carcinoma. The seventh sickle cell nephropathy. Am J Surg Pathol. 1995 Jan;19(1):1-11. https://pubmed.ncbi.nlm.nih.gov/7528470/

A Model Linking Sickle Cell Hemoglobinopathies and SMARCB1 Loss in Renal Medullary Carcinoma. Clin Cancer Res. 2018 May 1;24(9):2044-2049. https://pubmed.ncbi.nlm.nih.gov/29440190/

Updated Recommendations on the Diagnosis, Management, and Clinical Trial Eligibility Criteria for Patients With Renal Medullary Carcinoma. Clin Genitourin Cancer. 2019 Feb;17(1):1-6. https://pubmed.ncbi.nlm.nih.gov/30287223/

Five decades of urologic pathology: the accelerating expansion of knowledge in renal cell neoplasia. Hum Pathol. 2020 Jan;95:24-45. https://pubmed.ncbi.nlm.nih.gov/31655169/

GG Malouf, NM Tannir, P Rao, P Msaouel. Renal Medullary Carcinoma in Rare Kidney Tumors.

Comprehensive Molecular Characterization Identifies Distinct Genomic and Immune Hallmarks of Renal Medullary Carcinoma. Cancer Cell. 2020 May 11;37(5):720-734.e13. https://pubmed.ncbi.nlm.nih.gov/32359397/

The DNA sequence of human chromosome 22. Nature. 1999 Dec 2;402(6761):489-95. https://pubmed.ncbi.nlm.nih.gov/10591208/

High-intensity exercise is a risk factor for renal medullary carcinoma in individuals with sickle cell trait. Preprint.

Atypical carcinoma of kidney originating from collecting duct epithelium. Urology. 1982 Jan;19(1):89-92. https://pubmed.ncbi.nlm.nih.gov/7058597/

Genes affecting the regulation of SUC2 gene expression by glucose repression in Saccharomyces cerevisiae. Genetics. 1984 Dec;108(4):845-58. https://pubmed.ncbi.nlm.nih.gov/6392017/

Purification and biochemical heterogeneity of the mammalian SWI-SNF complex. EMBO J. 1996 Oct 1; 15(19): 5370–5382. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC452280/

On Breast Malignancy and Military Burn Pit Exposure Jun 21, 2021

Video version of this podcast: https://youtu.be/B8LLf7DkR5U

Chubbyemu video of KT: https://youtu.be/LKNfFm0QDXQ

Dr Bora Lim can be reached at https://www.twitter.com/naborala

Burn pits are a waste management tool for armed forces overseas. However, the nature of waste today is different than half a century ago. The smoke, fumes, and particulate matter that have been observed emanating from these pits contain a heterogeneous variety of materials. Exact exposure levels are not known in veterans, however many of these materials are known to be linked to long term health effects and some have been classified and recognized as carcinogens via retrospective analysis in humans and laboratory experiments. The particulate matter produced from these burn pits can also deposit into the earth and during weather events such as dust storms, can circulate the particles to local inhabitants, potentially causing health effects for them, years later. Recognizing these long term health effects will enable people to not make these mistakes again, and to help those who have been exposed.

References:

VA Burn Pit Registry: https://veteran.mobilehealth.va.gov/AHBurnPitRegistry

Source Apportionment of Airborne Dioxins, Furans and Polycyclic Aromatic Hydrocarbons at A U.S. Forward Operating Air Base During Iraq https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978146/

Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan https://www.nap.edu/catalog/13209/long-term-health-consequences-of-exposure-to-burn-pits-in-iraq-and-afghanistan

Polychlorinated Dibenzo-para-Dioxins and Polychlorinated Dibenzofurans. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 69. https://publications.iarc.fr/Book-And-Report-Series/Iarc-Monographs-On-The-Identification-Of-Carcinogenic-Hazards-To-Humans/Polychlorinated-Dibenzo--Em-Para-Em--Dioxins-And-Polychlorinated-Dibenzofurans-1997

Dioxin Revisited: Developments Since the 1997 IARC Classification of Dioxin as a Human Carcinogen https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1247514

Serum dioxin concentrations and breast ca risk in the Seveso Women's Health Study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240906/

Detection of hyperdiploidy and chromosome breakage in interphase human lymphocytes following exposure to the benzene metabolite hydroquinone using multicolor fluorescence in situ hybridization with DNA probes. https://pubmed.ncbi.nlm.nih.gov/7517507/

A Discussion On Over-The-Counter Cough Syrup Misuse May 24, 2021

Video version of this podcast: https://youtu.be/oP_mJmWrfTQ

Chubbyemu video of this case: https://www.youtube.com/watch?v=WPxb2IG9MOk

Featuring: Dr Sonal Jagasia, MD, MPH. Psychiatrist in private practice.

Dextromethorphan is an over the counter cough medicine. It is for coughs. Misuse of it can cause life threatening side effects.

References:

Dextromethorphan, chlorphenamine and serotonin toxicity: case report and systematic literature review. https://pubmed.ncbi.nlm.nih.gov/21175434/

Case of Serotonin Syndrome Initially Presenting as Diffuse Body Pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196581/

Serotonin Syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832

Bromism: An overlooked and elusive toxidrome from chronic dextromethorphan misuse. https://pubmed.ncbi.nlm.nih.gov/31864868/

Dextromethorphan-induced serotonin syndrome. https://pubmed.ncbi.nlm.nih.gov/19238739/

Cognitive Deterioration from Long-Term Misuse of Dextromethorphan:A Case Report. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188627/

Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications. https://pubmed.ncbi.nlm.nih.gov/19101060/

"DXM": a new drug of. https://pubmed.ncbi.nlm.nih.gov/9624331/

Hepatitis From Possibly Contaminated Alkaline Water Apr 12, 2021

This episode is up to date as of 11 April 2021

Video version of this podcast: https://youtu.be/dsZzKzGdgTo

Statement from water company CEO: https://www.youtube.com/watch?v=faCsru9Ctgk

Inside Edition video about this case: https://www.youtube.com/watch?v=lmEpmyc7g9Y

Local News talking about the water: https://www.youtube.com/watch?v=oGQJcnlk5ag

On March 13, the FDA was alerted to five cases of acute non-viral hepatitis (resulting in acute liver failure) in infants and children that occurred in November 2020 with an unknown cause reported to the Southern Nevada Health District. All five patients had been hospitalized but have since recovered. All patients were reported to have consumed “Real Water” brand alkaline water. These patients came from four different households. Five additional people, two adults and three children, from two of the four households were reported to have experienced other symptoms as well. Less severe symptoms included fever, vomiting, nausea, loss of appetite, and fatigue.

A Grandma Collapsed From Abdominal Pain. This Is What Happened To Her Colon. Apr 05, 2021

Chubbyemu video: https://www.youtube.com/watch?v=1MggKIfEld4

Heme Review video: https://www.youtube.com/watch?v=mPHXldh4_H4

Chubbyemu YouTube channel: https://www.youtube.com/channel/UCKOvOaJv4GK-oDqx-sj7VVg

Heme Review YouTube channel: https://www.youtube.com/channel/UCNSoNc9s67nfOGlCXSu5VsA

References:

Potential Benefits of Dietary Fibre Intervention in Inflammatory Bowel Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926452/

Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia https://academic.oup.com/ajcn/article/70/4/466/4729069

Anaphylaxis following psyllium ingestion https://pubmed.ncbi.nlm.nih.gov/6736485/

Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia https://academic.oup.com/ajcn/article/71/6/1433/4729388

Potential Benefits of Dietary Fibre Intervention in Inflammatory Bowel Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926452/

Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia https://academic.oup.com/ajcn/article/70/4/466/4729069

Anaphylaxis following psyllium ingestion https://pubmed.ncbi.nlm.nih.gov/6736485/

Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia https://academic.oup.com/ajcn/article/71/6/1433/4729388

Small Bowel Obstruction Secondary to a Metamucil Bezoar: Case Report and Review of the Literature https://pubmed.ncbi.nlm.nih.gov/29085697/

The role of dietary fibre in the human colon https://pubmed.ncbi.nlm.nih.gov/6257366/

Intestinal obstruction caused by a laxative (Psyllium): A case report and review of the literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197948/

Interview With A Stage 4 Lung Cancer Survivor (Jill Hamer-Wilson) Mar 30, 2021

Video version of this interview: https://youtu.be/oLe9UdL-qIk

Jill's Blog: https://throughthevalley.ca

White Ribbon Project: https://twitter.com/TheWRP4LC

LUNGevity Foundation: https://lungevity.org

GO2 Foundation: https://go2foundation.org

Lung Cancer Canada: https://www.lungcancercanada.ca

Lung Foundation Australia: https://lungfoundation.com.au

Lung Cancer Europe (LUCe): https://www.lungcancereurope.eu

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Some Chubbyemu Videos That I Might Not Be Able To Make Mar 20, 2021

Please note the CONTENT WARNING at the beginning-- there's a reason I can't make the videos as described in this episode. They may surface in a different form at some time in the future.

Heme Review YouTube: https://www.youtube.com/channel/UCNSoNc9s67nfOGlCXSu5VsA

Tweet me: https://www.twitter.com/hemereview

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BONUS- Interview With A Rare Dinitrophenol Accident Survivor (DNP For Weight Loss) Mar 03, 2021

Video of this interview: https://youtu.be/o15HCjtSkug

Chubbyemu video https://youtu.be/ChPeG19qKUo

Christopher's recount of his case: https://youtu.be/7BpymtR2vpA

2,4-Dinitrophenol (DNP) is a chemical that is not approved for weight loss. It is a classic case of efficacy, but without safety in the setting of weight loss. This setting of weight loss can be prone to chemical misuse, further exacerbating understanding in human systems. Christopher is one of 2 - 3 cases documented in literature to have survived an accident with DNP for weight loss. As of 2021, one organization has permission from the US FDA to investigate DNP in some neurodegenerative disorders. These are rare diseases with limited standards of care, therefore extenuating circumstances to find anything that could potentially improve patient outcomes.

References:

Role of dantrolene in dinitrophenol (DNP) : A continuing question? Am J Emerg Med. 2019 Jun;37(6):1216.e1-1216.e2. https://pubmed.ncbi.nlm.nih.gov/30948257/

2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity . J Med Toxicol. 2011 Sep;7(3):205-12. https://pubmed.ncbi.nlm.nih.gov/21739343/

Ambient temperature and mortality from unintentional . JAMA. 1998 Jun 10;279(22):1795-800. https://pubmed.ncbi.nlm.nih.gov/9628710/

Beware the yellow slimming pill: fatal 2,4-dinitrophenol. BMJ Case Rep. 2016 Apr 4;2016. https://pubmed.ncbi.nlm.nih.gov/27045052/

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate. BMJ Case Rep. 2018 Dec 19;11(1):e225323. https://pubmed.ncbi.nlm.nih.gov/30573533/

The effect of 2,4-dinitrophenol on adipose-tissue metabolism. Biochem J. 1969 Feb;111(4):431-44. https://pubmed.ncbi.nlm.nih.gov/4388239/

The mechanism of uncoupling of oxidative phosphorylation by 2,4-dinitrophenol. J Biol Chem. 1967 Oct 25;242(20):4577-83. https://pubmed.ncbi.nlm.nih.gov/4964808/

MECHANISMS OF DINITROPHENOL TOXICITY. Simon E.W. Biological Reviews. Vol 28. (4). Nov 1953.

Identification and Importance of Brown Adipose Tissue in Adult Humans. https://www.nejm.org/doi/full/10.1056/NEJMoa0810780

Mitochondrial uncoupling as a target for drug development for the treatment of obesity. Obes Rev. 2001 Nov;2(4):255-65. https://pubmed.ncbi.nlm.nih.gov/12119996/

LC-MS-MS analysis of 2,4-dinitrophenol and its phase I and II metabolites. J Ana Toxicol. Jan-Feb 2007;31(1):55-61. https://pubmed.ncbi.nlm.nih.gov/17389084/

Uncouplers of oxidative phosphorylation. Environ Health Perspect. 1990 Jul;87:213-8. https://pubmed.ncbi.nlm.nih.gov/2176586/

Texas Woman Charged with Selling Misbranded

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/press-releases/texas-woman-charged-selling-misbranded-drug

A Brief Discussion Of Dinitrophenol In The Setting Of Weight Loss Mar 03, 2021

Patient CE's personal recount of case: https://youtu.be/7BpymtR2vpA

Patient CE's Interview: https://youtu.be/o15HCjtSkug

Chubbyemu video on this case: https://youtu.be/ChPeG19qKUo

Heme Review video version: https://youtu.be/jgDUMNaVqHg

2,4-Dinitrophenol (DNP) is a chemical that is not approved for weight loss in the United States. It is a classic case of efficacy, but without safety in the setting of weight loss. This setting of weight loss can be prone to chemical misuse, further exacerbating understanding in human systems. Christopher is one of 2 - 3 cases documented in literature to have survived an accident with DNP for weight loss. As of 2021, one organization has permission from the US FDA to investigate DNP in some neurodegenerative disorders. These are rare diseases with limited standards of care, therefore extenuating circumstances to find anything that could potentially improve patient outcomes.

References:

Role of dantrolene in dinitrophenol (DNP) : A continuing question? Am J Emerg Med. 2019 Jun;37(6):1216.e1-1216.e2. https://pubmed.ncbi.nlm.nih.gov/30948257/

2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity . J Med Toxicol. 2011 Sep;7(3):205-12. https://pubmed.ncbi.nlm.nih.gov/21739343/

Ambient temperature and mortality from unintentional . JAMA. 1998 Jun 10;279(22):1795-800. https://pubmed.ncbi.nlm.nih.gov/9628710/

Dinitrophenol as a Medicine. Cells. 2019 Mar; 8(3): 280. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468406/

The Interaction of Highly Active Uncouplers With Mitochondria. Biochimica et Biophysica Acta, 639 (1981) 225-242.

Beware the yellow slimming pill: fatal 2,4-dinitrophenol. BMJ Case Rep. 2016 Apr 4;2016. https://pubmed.ncbi.nlm.nih.gov/27045052/

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate. BMJ Case Rep. 2018 Dec 19;11(1):e225323. https://pubmed.ncbi.nlm.nih.gov/30573533/

The effect of 2,4-dinitrophenol on adipose-tissue metabolism. Biochem J. 1969 Feb;111(4):431-44. https://pubmed.ncbi.nlm.nih.gov/4388239/

The mechanism of uncoupling of oxidative phosphorylation by 2,4-dinitrophenol. J Biol Chem. 1967 Oct 25;242(20):4577-83. https://pubmed.ncbi.nlm.nih.gov/4964808/

MECHANISMS OF DINITROPHENOL TOXICITY. Simon E.W. Biological Reviews. Vol 28. (4). Nov 1953.

Identification and Importance of Brown Adipose Tissue in Adult Humans. https://www.nejm.org/doi/full/10.1056/NEJMoa0810780

Mitochondrial uncoupling as a target for drug development for the treatment of obesity. Obes Rev. 2001 Nov;2(4):255-65. https://pubmed.ncbi.nlm.nih.gov/12119996/

LC-MS-MS analysis of 2,4-dinitrophenol and its phase I and II metabolites. J Ana Toxicol. Jan-Feb 2007;31(1):55-61. https://pubmed.ncbi.nlm.nih.gov/17389084/

Uncouplers of oxidative phosphorylation. Environ Health Perspect. 1990 Jul;87:213-8. https://pubmed.ncbi.nlm.nih.gov/2176586/

Texas Woman Charged with Selling Misbranded

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/press-releases/texas-woman-charged-selling-misbranded-drug

The Body After Eating Several Pounds Licorice Candy Oct 05, 2020

Based on N Engl J Med 2020; 383:1263-1275. https://www.nejm.org/doi/full/10.1056/NEJMcpc2002420

Video version of this podcast: https://youtu.be/8lGmvFkAMOU

Chubbyemu video of this case: https://youtu.be/qg76qIZ4BQ8

Laxative Brownie video from 2017: https://youtu.be/TMy0vJfKvzI

Tweet me: https://twitter.com/hemereview

IG me: https://instagram.com/hemereview

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Licorice candy has glycyrrhizin which increases cortisol (stress hormone) levels in the body. This causes hypokalemia. Hypo- low. Kal- kalium (potassium). emia- presence in blood. Potassium signals muscle relaxation. Low potassium, low relaxation. Heart can't relax, then it stops. Real licorice candy is not easy to get in the United States. It's not at big chain grocery stores. Most of what you can buy from the big brands is licorice flavored, and won't do this.

References:

A 54-Year-Old Man with Sudden Cardiac Arrest. N Engl J Med 2020; 383:1263-1275. https://www.nejm.org/doi/full/10.1056/NEJMcpc2002420

The Pharmacological Activities of Glycyrrhizinic Acid (“Glycyrrhizin”) and Glycyrrhetinic Acid. Sweeteners. 2018 : 245–261. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123798/

Sustained Leukocyte Count during Rising Cortisol Level. Acta Haematologica 118(2):73-6. https://www.researchgate.net/publication/6298458

https://www.nobelprize.org/prizes/medicine/1964/bloch/lecture/

Licorice-Induced Hypermineralocorticoidism. N Engl J Med 1991; 325:1223-1227. https://www.nejm.org/doi/full/10.1056/NEJM199110243251706

Young WF, et. al. Apparent mineralocorticoid excess syndromes (including chronic licorice ingestion). In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2019.

Quinkler M, Stewart PM. Hypertension and the cortisol-cortisone shuttle. J Clin Endocrinol Metab 2003; 88:2384.

Funder JW. Apparent mineralocorticoid excess. J Steroid Biochem Mol Biol 2017; 165:151.

Funder JW. 11 beta-Hydroxysteroid dehydrogenase: new answers, new questions. Eur J Endocrinol 1996; 134:267.

TikTokers Taking Too Much Benadryl Sep 15, 2020

YouTube Video Version: https://youtu.be/ZNA_NtcutYY

Chubbyemu Video: https://youtu.be/NaAFOrudj0g

References:

The Pharmacology and Use of H1-Receptor-Antagonist. N Engl J Med 1994; 330:1663-1670

Advances in H1-Antihistamines. N Engl J Med 2004; 351:2203-2217

Cardiac arrest caused by diphenhydramine overdose. Acute Med Surg. 2018 Oct; 5(4): 380–383.

IV Lipid Emulsion Infusion in the Treatment of Severe Diphenhydramine. Am J Case Rep. 2019 May 29;20:758-763.

Diphenhydramine with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion. West J Emerg Med. 2014 Nov; 15(7): 855–858.

Diphenhydramine in a 26-year-old Woman. J Emerg Nurs. 2008 Dec;34(6):543-4.

Heatstroke (from a Bitcoin Mining Accident) Aug 15, 2020

YouTube Video Version: https://youtu.be/QSXzRWiuvxE

Chubbyemu video of this case ▶️ https://youtu.be/fr8bp8a2QS4

The Body After Drinking A Snowglobe ▶️ https://youtu.be/elzijduKNS8

The Body After 2 Gallons Coffee In 3 Hours ▶️ https://youtu.be/rn-WLpa_nyQ

Music by @Lifeformed

Heatstroke is a serious problem and the heatwaves that cause it, claim more lives on average than any other weather event in USA. While generally thought to affect the elderly and the very young, it can affect people of all ages, not just because of the heat in the environment (classic heatstroke) but also because of activity (exertional heatstroke). The problems caused by heatstroke sometimes happen but don't appear clinically, like GI ischemia.

Bitcoin is a decentralized cryptocurrency that's used in peer to peer transactions. This happened in 2011 when individual people could still mine coins, but now, miners are usually pools or in large facilities in places that have cheap electricity and cool climate to save on computer cooling costs.

The followup: https://web.archive.org/web/20110612111539/http://www.bitcoinminingaccidents.com/

References:

0 Heat Stroke. Compr Physiol 5:611-647, 2015.

1 Heatstroke N Engl J Med 2019; 380:2449-2459.

2 Mechanisms of circulatory and intestinal barrier dysfunction during whole body hyperthermia. Am J Physiol Heart Circ Physiol 280: H509–H521, 2001.

3 The Impact of Mild Heat Stress During Prolonged Running On Gastrointestinal Integrity, Gastrointestinal Symptoms, Systemic Endotoxin and Cytokine Profiles. Int J Sports Med 2018; 39: 255–263.

4 Heat stroke: Role of the systemic inflammatory response. J Appl Physiol (1985). 2010 Dec;109(6):1980-8.

5 Endotoxaemia in exhausted runners after a long-distance race. S Afr Med J. 1988 May 7;73(9):533-6.

6 Pathogenesis of nonocclusive ischemic colitis. Ann Surg. 1986 Jun;203(6):590-9.

Methanol Hand Sanitizer Aug 01, 2020

Methanol-contaminated hand sanitizer has been on sale in the USA during COVID-19 pandemic. The FDA has issued a warning against this, and have listed the brands. Most stores that are selling these brands have pulled them from shelves.

Methanol is a toxic alcohol that can cause blindness. Its antidote is ethanol, which is the alcohol that people drink casually, however management needs to be done by a healthcare professional, as methanol hangs around in the body for several days.

The case presented here predates the pandemic by almost 20 years. However, methanol skin absorption has been identified as an industrial work hazard since the early 20th century.

Heme Review YouTube Channel: https://www.youtube.com/channel/UCNSoNc9s67nfOGlCXSu5VsA

Heme Review Twitter: https://www.twitter.com/hemereview

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Heme Review FB: https://www.facebook.com/hemereview

References:

[0] Case report: Percutaneous absorption and distribution of methanol in a homicide.J Ana Toxicol. 2005 Oct;29(7):734-7. https://pubmed.ncbi.nlm.nih.gov/16419410/

[1] FDA Methanol List: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use

[2] B.Dutkiewicz, J.Konczalik, and W.Karwaki. Skin absorption and per os administration of methanol in men. Int. Arch. Occup. Environ. Health 47(1): 81-88 (1980).

[3] Material Safety Data Sheet. SNAP Octane Booster, Product #8-290, SNAP Products Inc. Pandora, OH, 1993.

Crystallopathies Jul 27, 2020

This episode is about the pathophysiology on crystallopathies. The cellular pathways involved unify multiple concepts and multiple branches of medicine, from toxicology to cardiology to rheumatology and oncology.

Heme Review YouTube Channel: https://www.youtube.com/channel/UCNSoNc9s67nfOGlCXSu5VsA

References:

[0] Crystallopathies. N Engl J Med 2016; 374:2465-2476. https://www.nejm.org/doi/full/10.1056/NEJMra1601611

[1] Recent advances in the mechanisms of NLRP3 inflammasome activation and its inhibitors. Cell Death & Disease. Volume 10, Article number: 128 (2019). https://www.nature.com/articles/s41419-019-1413-8

[2] The Inflammasome. Molecular Cell. VOLUME 10, ISSUE 2, P417-426, AUGUST 01, 2002. https://www.cell.com/molecular-cell/fulltext/S1097-2765(02)00599-3

[3] Silica crystals and aluminum salts mediate NALP-3 inflammasome activation via phagosomal destabilization. Nat Immunol. 2008 Aug; 9(8): 847–856. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834784/

[4] Tumor Cell–Derived IL1β Promotes Desmoplasia and Immune Suppression in Pancreatic Cancer. Cancer Res 2020;80:1088–101. https://cancerres.aacrjournals.org/content/80/5/1088

The Body After Drinking A Snowglobe (High Anion Gap Metabolic Acidosis) Jul 21, 2020

Video version of episode: https://www.youtube.com/watch?v=elzijduKNS8

Chubbyemu case: https://youtu.be/UrbylXMU8Mw

Most snowglobes are just made of water, but some can contain ethylene glycol. Most of those usually don't contain enough ethylene glycol to cause damage, but keep the word "usually" in mind. A homemade snowglobe can contain concentrations of anything, which is what happened in this case.

Ethylene glycol can cause a profound high anion gap metabolic acidosis, and we'll explain the science, chemistry and physiology behind that in this episode.

References:

Delayed ethylene glycol presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report. Journal of Medical Case Reports volume 4, Article number: 220 (2010).

Multiple Cranial Nerve Deficits After Ethylene Glycol. Ann Emerg Med. 1991 Feb;20(2):208-10. https://pubmed.ncbi.nlm.nih.gov/1996809/

Antidotes OH that form toxic metabolites. Br J Clin Pharmacol. 2016 Mar; 81(3): 505–515. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767193/

Toxic Alcohols. N Engl J Med 2018; 378:270-280. https://www.nejm.org/doi/full/10.1056/NEJMra1615295

Ethylene glycol ingestion masked by concomitant ethanol ingestion. Case Reports 2012;2012:bcr1220115326. https://casereports.bmj.com/content/2012/bcr.12.2011.5326

Challenges in the Diagnosis of Ethylene Glycol Poisoning. Ann Clin Biochem. 2014 Mar;51(pt2):167-78. https://pubmed.ncbi.nlm.nih.gov/24215789/

Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore) 1977;56:38-54.

Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis: a review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore) 1998;77:73-82.

Judge BS. Metabolic acidosis: differentiating the causes in the poisoned patient. Med Clin North Am 2005;89:1107-1124.

Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786-1795. https://www.nejm.org/doi/full/10.1056/NEJMra020617

A 49 Year Old Man With Obtundation Followed By Agitation And Acidosis. N Engl J Med 2015; 372:465-473. https://www.nejm.org/doi/full/10.1056/NEJMcpc1410940

Integration of Acid-Base And Electrolyte Disorders. N Engl J Med 2014; 371:1821-1831. https://www.nejm.org/doi/full/10.1056/NEJMra1215672

Calcium Kidney Stones. N Engl J Med 2010; 363:954-963. https://www.nejm.org/doi/full/10.1056/NEJMcp1001011

What Happens In A Caffeine Overdose May 19, 2020

Max recommended amount of caffeine per day is 400mg.

@Chubbyemu case report video ► https://youtu.be/wj_AOzSSDMM

Video version of this episode ► https://youtu.be/rn-WLpa_nyQ

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