A Man Dryscooped 35000 Milligrams Of
Caffeine. This Is What Happened To His Organs. ET is a 37 year old man, presenting to
the emergency room, agitated, confused, and complaining of a massive headache.
Paramedics tell the admitting nurse that they saw him have a seizure in
the ambulance. When it was finished, they noticed that his heart
was beating erratically. ET was devoted to his gym lifestyle. In his
early 20s, in college, he knew that that age was the prime time in his entire life
to build not only a solid base of muscle, but also a solid foundation of discipline.
He ate clean, he didn’t party, he slept well and consistently put in his hours to become
as strong as he could be. And it paid off, even though he knew he wouldn’t be able to keep up to be as
strong later in life as he was in college ET never really bought into the hype
of supplements. He knew consistency in 1)eating well, and 2) training well were
always the most important.
But when he did take supplements, he’d save money by buying
raw ingredients, and creating his own mix. One day while transferring ingredients from
the wholesaler’s bags to his own containers, ET mislabeled the caffeine powder for branch chain
amino acids. As he mixed his custom supplement blend, he thought something was different. Usually
the amino acids had a particular texture and didn’t clump up in to chunks, like how powdered
caffeine does. Even though it looked and felt a little different, he thought maybe the factory
used a different way to manufacture things, maybe it was a different batch. He wasn’t really
paying that much attention this time around. Everything was white powder and it was just hard
to tell a difference. As the mixture was ready, ET had no idea of the sheer amount of caffeine
powder in this particular mix.
That just a single scoop alone, contained a lethal dose of
caffeine, as he placed the container on his shelf. The next day, ET prepared
his peri workout supplement, something to drink and keep him
hyped during his training session, but he was completely oblivious to the fact that
he was about to consume a lethal dose of caffeine. In the middle of one of his sets,
he decided he would dry scoop it, as he popped the powder in to his
mouth and washed it down with some drink.
As he started swallowing,
he noticed it tasted really funny, kinda bitter with a peculiar after taste. Maybe
the factory really changed those amino acids. Immediately after swallowing 35000 milligrams of
caffeine, ET noticed something weird. He wasn’t sure what was wrong with the taste. He thought the
workout was a little weird while he was doing it, so maybe he just tweaked something,
he thought. As the minutes passed, ET started feeling like he was getting hit by
a slow moving train. He felt his stomach was burning, but his heart was starting to beat
faster and faster. He started feeling dizzy, as it felt like an animal was chewing its way
out of his stomach.
He felt an overwhelming sense of doom as he started hyperventilating.
Unknowingly, ET’s pupils start to dilate as his vision starts to blur. He stumbled around and
in the shuffle, he felt a tingle through his cheeks as liquid gushed out under his
tongue, and he heaved into the toilet. At home now, ET laid down on the floor. He
could feel a massive pain in his chest. He called for 911 because he was in such
a horrible panic. In the ambulance now, ET he finally has his first seizure as he’s
brought to the emergency room where we are now. Clearly, all of ET’s problems are because of
the 35000 milligrams of caffeine he accidentally consumed in his home-mixed workout supplement, but
ET doesn’t know what he really consumed, he just knew all of this started after he drank that mix.
And doctors also have no idea what happened, but they noticed that his body temperature was high,
and a blood test finds that ET has hyperglycemia.
Hyper meaning high. Glyc from Ancient Greek
origin of the word glucose referring to sugar. And -emia meaning presence in blood. High
sugar presence in blood. If ET’s heart rate is high, if his heart rhythm is erratic,
if he’s shaking and he just had a seizure, then you could reasonably guess that maybe
he’s hopped up on a chemical stimulant. His hyperglycemia was from the stimulant triggering
a chemical message to the body that it’s time to “fight or flight,” cueing the body to
immediately mobilize glucose stores from his body in an effort to supply cells and muscle with
energy in order to perform that fight or flight.
ET appears to be experiencing sympathomimetic
toxidrome. Toxidrome, a combination of the words syndrome, referring to a group of symptoms
happening simultaneously, and toxin being a poison. Sympatho referring to the sympathetic
nervous system, the one responsible for fight or flight response as opposed to rest and
digest and mimetic meaning an imitation of. ET has symptoms happening together,
that’s imitating a response that would be elicited by a natural function
of one part of the nervous system, caused by a massive ingestion of a toxin,
unknown to ET and the medical team, but known to us as 35000 milligrams of caffeine,
almost 90 times the daily recommended limit. As the medical team reads the results of ET’s
blood test they find that he has hypokalemia. Hypo- meaning low. Kali referring to potassium, or
more formally Kalium as shown by its symbol on the period table of elements. Low potassium presence
in blood. But what does this mean? Potassium, like sodium above it on the periodic table, is
an electrolyte that signals to cells to do, or to stop doing things.
Sodium is primarily outside
of cells, and potassium is primarily inside cells. Moving in and out and being present or absent
are how these electrolytes send their messages. One place that relies heavily on these signals
is muscle tissue. The nerves signal for a contraction by sending neurotransmitters. Sodium
enters the muscles to signal for a contraction. Calcium enters, telling the muscle to commit to a
contraction. And potassium signals relaxation. Too much potassium means the muscles relax for a long
time, and too little means the muscles wont stop contracting, bringing us back to hypokalemia.
If there’s low potassium presence in blood, and too little potassium means that
the muscles wont stop contracting, then it could make sense why ET is so jittery
and why he’s shaking. The heart is a muscle too and if it can’t relax properly, then this could
explain why ET’s heart is beating so erratically. And as the medical team gets ready to admit ET
into the hospital, his heart rhythm is so fast and so erratic, that his heart suddenly stops
beating.
Doctors scramble to resuscitate ET. We know that ET accidentally consumed a lethal
dose of caffeine. Hyperglycemia could be a result of that “fight or flight” response and
hypokalemia could have caused his twitching muscles and his cardiac arrest, but why did these
happen? Well, caffeine is found in nature in cocoa beans and tea leaves. The interesting
thing about caffeine’s chemical structure, is that it’s similar in shape to something else
that’s produced and used everywhere inside humans, called adenosine. Our DNA is made of it. You might
recognize it through the chemical manufactured by our mitochondria and used by our cells for
energy, ATP, Adenosine Triphosphate. In the body, certain chemicals fit inside spaces on the cell
surface, or maybe it’ll fit into something inside the cell. Binding into these spaces tells
the cells to do, or to stop doing things. So, a chemical needs the physical shape to
fit in. It’s kind of like a square peg, that should fit in a square hole. And this is
where all the problems with caffeine poisoning happen. In a brief moment, ET tells doctors
that all of this started happening after he swallowed some supplements post-workout.
It
was OK that he created his own mix because he knew exactly which ingredients to list,
and this tells the medical team everything they need to know, because caffeine was
the only ingredient capable of doing this. In the brain, adenosine helps balance
neurotransmitters, one of which helps calm the brain preventing overexcitation.
Because caffeine is shaped like adenosine, it fits into those places in the brain instead
of adenosine. At regular amounts you’d drink in one coffee, it’s not a huge deal.
But
at lethal dose amounts, like in ET’s case, it can cause such an extreme imbalance that
electricity discharges everywhere in ET’s brain, explaining his seizure. You can start
to see why all of this is happening now. In the heart, adenosine helps regulate pace maker
cells. If caffeine is there, preventing adenosine from performing its functioning, then those
pace maker cells can’t be regulated anymore. The heart starts to lose its normal pace, and
it starts to beat erratically. But it doesnt stop here. In the blood vessels, adenosine helps
maintain how relaxed and constricted blood vessels are. If a huge dose of caffeine is blocking it,
then the blood vessels tense up and constrict, increasing blood pressure and decreasing blood
flow. This is a problem in the brain because blood vessels there can be constricted, limiting
blood flow during a time where over excitation would cause the cells to need more oxygen for
the increased activity, but that blood can’t get there because of the vasoconstriction.
But this is only the start of ET’s problems.
This brings us back to the idea of “fight or
flight.” Caffeine, in the setting of overdose, sets off a chemical cascade in the cells.
As this signal amplifies itself, it ends with the release of adrenaline in to the blood.
Typically, when the body is in immediate stress, adrenaline is released to activate that “fight or
flight” response. Almost immediately, deposits of sugar in the liver are released into the blood,
so that muscles can use them for energy. The heart immediately starts beating faster to supply blood
to the rest of the body. But this brings us back to the name, sympathomimetic toxidrome. If the
fight or flight response is from the sympathetic nervous system, but adrenaline is a hormone
released into the blood from glands that are above the kidneys which are not part of the
nervous system, then it means there could be another chemical released from the nervous system
due to this fatal dose of caffeine.
Noradrenaline is that chemical, and it quickly spreads all
throughout throughout ET’s nervous system, sending extreme signals. It gets to his muscles,
which now have an abundance of sugar to use for energy because of hyperglycemia. The incessant
signal from the brain and the nerves cause the muscles to twitch. Because the muscles are so
active now, they’re producing heat, explaining why ET’s body temperature was so high. Because
they’re so active they’re producing metabolic wastes. The body needs to balance this waste out,
so it takes potassium from the blood and shoves it into the cells explaining his hypokalemia. But
potassium is supposed to signal muscle relaxation, and there isn’t enough of it in the blood to make
that signal.
And this is happening at a time when adrenaline and noradrenaline and sending signals
nonstop telling the muscles to contract, and without that proper relax signal, the muscle of
the heart starts beating more and more erratically until suddenly, it isn’t beating anymore. The
stopping of blood flow means oxygen can’t get to ET’s muscles, during a time when their energy
demand is high. The muscles and the brain start to starve of oxygen and die. As the medical
team keeps trying to resuscitate ET because his heart keeps stopping, the dead muscle tissue
can leak its contents and spill protein and iron in the blood.
When the heart starts circulating
blood again, those dead muscle cell remnants can collect in his kidneys, and they can start
damaging the tubules causing permanent injury. This is what happened to ET’s brain, his heart,
his muscles, and his kidneys after drinking 35,000 milligrams of caffeine. Is there
anything that can be done for ET? Maybe. This brings us back to the chemical structure
of caffeine. First, the molecule is small and light. This could make it easy to handle. Second,
caffeine is hydrophilic. Hydro meaning water, and -philic meaning affinity for. This means
that caffeine dissolves preferentially in water, as opposed to oil, which doesnt mix well with
water, so caffeine wouldn’t distribute widely into fat tissue in the body. All of this meaning that
caffeine is more likely to stay in the blood, than hide inside the organs where it would be
impossible to extract out, once it’s in. Because of this, it could be possible to “clean” ET’s
blood of caffeine. He’s hooked up to a dialysis machine where his blood flow is diverted to a
machine so that it can remove caffeine.
The clean blood is then sent back to his body for normal
function. Because ET drank his caffeine recently, it may not yet be too late, it might still
be possible to decontaminate his stomach, and prevent the caffeine from absorbing into
his blood. Activated charcoal was given to him in the hopes that the remaining caffeine in
his stomach would stick to the surface of the charcoal, not absorb into the blood to do its
damage, and eventually pass out of his body. Hours after the dialysis was started, ET no
longer had any seizures and his heart rhythm started to normalize. Hyperglycemia isn’t life
threatening in this context, and it too started to resolve soon after.
Because his hypokalemia
was a function of potassium shift into his cells, his body didn’t actually lose potassium, so
aggressively replacing it was not necessary, an equilibrium was reestablished. Days
later, ET was able to make a full recovery as he returned home, and returned to his original
affirmation, that supplements are a nice to have, but food and consistent training are
must haves for true gains in the gym. Thanks for watching. Take
care of yourself. And be well..
