A Dad Didn’t Brush His Teeth For 40 Days. This Is What Happened To His Kidneys.

A Dad Didn’t Brush His Teeth For 40 Days. This Is What Happened To His Kidneys.

A Dad Didn’t Brush His Teeth for 40 Days.
This Is What Happened To His Kidneys. CJ is a 46 year old man, presenting to the
emergency room with excessive thirst, abdominal discomfort, and shortness of breath. He tells
the admitting nurse that he had lost 15 pounds over the last 2 weeks and had developed a
pounding toothache. You see, CJ was a dad who lost everything.
Earlier in his life, he was a successful engineer, with a happy family. Five years ago, on his 41st birthday, CJ lost
his 5 year old son in a sudden freak accident. He returned to work from bereavement leave,
only to find he was laid off. His wife, unable to cope with tragedy, left him before year’s
end. Bankrupt and unable to find new work, CJ was
forced in to government housing to a poor part of town. He found comfort and affordability
in certain foods and gained over 250 pounds (114kg) in 4 years. About 2 months ago, CJ’s mother, his last
sense of hope in family, passed away. In his sadness, he laid in bed all day, only getting
up to go to the convenience store to eat. He no longer cared for his own personal hygiene—
no longer brushed his teeth, no longer bathed. Over the next few weeks, he noticed something
wrong when he had an unquenchable thirst. Because juice is fruit, it must be healthy,
so drink more of it, he thought. One day, he drank 2 gallons juice and urinated
every 15 minutes. Just a lot of extra liquid, he thought. On the surface, CJ didn’t appear to be well.
He had glucosuria, or sugar in his urine. This was combined with his polydipsia, his
unquenchable thirst, and polyuria, his frequent urination. His face was turgid- swollen and
bloated. Evaluation of his oral cavity found an infected tooth, which inflamed his oral
mucosa and formed multiple pustules along his gums, all because he no longer found it
necessary to brush his teeth. A blood test reveals CJ’s blood glucose
level is 800 mg / dL, more than 10 times that of normal. In the emergency room, CJ becomes more lethargic.
His toothache was pounding. His blood pressure was dropping, and in the wait for medical
care, he finally collapses into coma. Given this past history, there’s several
clues as to what’s going on. Most immediately, CJ is suffering from hyperglycemic crisis.
Hyper meaning high. Glyce referring to glucose, or sugar, the primary source of energy for
cells, and emia meaning presence in blood. High glucose presence in blood and crisis
meaning there was an underlying cascade of events that brought about CJ’s metabolic
derangement, which leads us to the first clue. Because he was urinating every 15 minutes,
there was a substantial net flow of water out of his body. His urine has a lesser concentration
of sugar in it compared to the juice, which means that glucose is accumulating and concentrating
in his blood. We can prove this Because CJ weighed over 400 pounds at admission,
his estimated blood volume was about 9 liters. Given his blood glucose level of 800 mg / dL,
there are 72 grams, almost a one fifth pound of sugar, floating around in the blood. The
average amount for a healthy man weighing around 175 pounds (79.4kg) is 4 grams, 18 times less than CJ. Because CJ drank 2 gallons (7.57 L) of juice which amounted to 850 grams of sugar, and 72 are present in his blood, then where are the other
700 grams? Well, there’s a bit of basic human physiology
to be known here. When you eat, food goes into your stomach, then to the small intestines,
where fats, proteins and sugars, absorb through the liver, then are delivered to the body
through the blood. Glucose enters cells because the body releases a hormone named insulin
into circulation in response to food, shifting sugar into muscle, liver, and fat tissue for
storage. The problem with CJ is that both his diet
and his class 3 obesity, defined by his body mass index, allowed for massive disturbances
in high blood glucose levels, based on his choice and amount of foods. This caused an
overabundance of insulin to be in his blood constantly. Because cells don’t want this
continuous influx of glucose, they downregulate, or decrease the number of insulin receptors,
meaning they won’t accept as much sugar from the blood, leaving it floating around
as they become increasingly insulin resistant. Over the last 4 years, CJ, through his diet
of bountiful sugary and fatty foods, saturated his tissues with glucose and his body converted
those stores to fat. Unable to handle the overabundance of sugar, the body left it in
the blood to accumulate, where it inevitably overloaded the kidneys and began to spill
into the urine explaining CJ’s glucosuria. This is the chronic, or long-term, physiologic
consequence of CJ’s gross hyperglycemia, but there is also a life-threatnening chemical
consequence as well. CJ is in hyperosmolar hyperglycemic state.
Hyperosmolar, describing the chemistry responsible for what’s happening. The interesting thing about glucose is that
it creates an osmotic gradient. Which means wherever it is, water will flow towards it. In this small science experiment, I fill an
outside pool with sugar water. I submerge a tube filled with distilled, sugar free,
water, and you’ll see that water leaves the tube, that water flows towards the sugar. So lets go back to the name of CJ’s problem,
hyperosmolar hyperglycemic state. Because there’s a large glucose presence in blood,
sugar is drawing water out of his cells, exerting a hyperosmolar effect. Because his cells are
losing water, his body thinks he is dehydrated and release signals to his brain to alert
him of thirst, explaining his polydipsia. Because water is getting drawn into his intravascular
space, it increases the flow of water to the kidneys, causing them to filter more urine
explaining his polyuria. The hyperglycemia begins to draw water out
of his brain, dehydrating it, causing his neurological deficits, resulting in coma.
As his cells begin to dry out and he persists in excessive urination, his body becomes massively
dehydrated, decreasing perfusion to the already dried out kidneys, and causing acute kidney
injury. With the failure of kidneys, what should be CJ’s urine is now floating around
in his blood, rotting his bones through an imbalance of calcium and phosphate, altering
his brain chemicals through excess nitrogen, and disrupting the electrophysiology of the
heart through potassium. All because his body could no longer handle glucose. At this point, it is impossible to directly
remove the sugar from his blood. Even if we drained CJ’s body and transfused in fresh,
euglycemic blood, it too would become hyperglycemic to the point of crisis because the pathogenesis
of hyperosmolar hyperglycemic state is metabolic in nature. All of this precipitated by CJ’s
abscessed tooth. Because CJ hadn’t brushed his teeth for
40 days, his tooth became inflamed and infected. This infection seeped into his gums and began
to spill into his systemic circulation, and spread throughout his body, causing septicemia.
A bacteria presence in blood. This forced his immune system to activate, and caused
adrenaline to release in response to the physiologic stress. Because adrenaline is usually released when
you get scared or excited, it forces the liver and muscles, sites of storage for glucose,
to quickly release sugar into the blood. This makes sense because to fuel a fight or flight
response, you need sugar in blood for cells to generate mechanical energy. But its
release is inappropriate in CJ meaning his hyperglycemia was not only onset by the juice
he drank and his overall diet, but was amplified by his own body through physiologic stress
induced by poor oral hygiene. If this continues untreated, the electrolyte abnormalities onset
by renal failure through dehydration will cause cardiac arrhythmias and lead to sudden
death. The notion of metabolic derangement arising
from hyperglycemic crisis was observed thousands of years ago. In 1500 BC, ancient Egyptian
physicians wrote about a “too great emptying of the urine” that attracted ants. It was later
found that sugar was responsible for attracting the insects. Ancient Chinese medical texts
describe sugar urine disease, who’s pronunciation tang niao bing preserved into Japanese and
Korean. We know this today to be diabetes and this hyperglycemic crisis alone is sufficient
to diagnose CJ with type 2 diabetes, the disorder where the body does create insulin but does
not respond to it. Contrast with type 1 diabetes where the body doesn’t create insulin at
all. The notion of diabetic coma was first described
in western literature in 1828 by German physician August von Stosch who described severe polydipsia,
polyuria and glucosuria followed by decline in mental status leading to death. In the early 1900s, a diabetes diagnosis was
a death sentence. Without insulin patients would inevitably suffer hyperglycemia from
eating, causing dehydration, kidney injury, and coma, leading to death. It was only in
1921 when Canadian physician Frederick Banting and group extracted insulin from cows that
diabetes became a chronic treatable illness. It wasn’t until 1957 when humans finally
understood that the pathogenesis and etiology of coma and kidney injury in hyperglycemic
hyperosmolar state were due to extracellular hypertonicity and cellular dehydration arising
from underlying metabolic derangement accompanied with a major precipitating factor. For CJ, we treat his condition first by treating
his infection with antibiotics and in his case, the abscessed tooth was removed. Because
his blood was hyperosmolar due to glucose, we dilute his blood by infusing water into
his veins. Rehydration efforts will amount to as much as 20 liters given over 48 hours.
This will mitigate his dehydration and reduce the plasma osmolality that was onset by hyperglycemia
and begin to perfuse the kidneys, delivering oxygen to the tissue and alleviating acute
injury, allowing them to filter urine and remove wastes, while restoring water back
into the cells. With the physiologic stress removed on treatment
of his tooth, some insulin sensitivity will be restored and administering insulin intravenously
will allow more water to shift back into the cells, as well as replete potassium, an
electrolyte which was forced out of the cell during hyperglycemic crisis and excreted in
large quantities during polyuria. Today, we have sophisticated therapies and
techniques to treat diabetes. We have drugs that sensitize cells to insulin. Before 1977,
insulin that was originally derived from grinding pig and cow pancreas, would inevitably cause
allergic reactions after long term use. After 1980, we have genetically engineered E. coli
bacteria with recombinant human DNA, enabling them to produce human insulin in unadulterated
form. This paved the way for short and long acting insulin analogs to alleviate acute
and chronic aberrations in glycemic levels and helps maintain glucose control in the
elderly, where hypoglycemia onset from incorrect insulin doses will cause dizziness and loss
of consciousness leading to falls, shattering bones and hips, leading to increased mortality
in the elderly. Despite all of these techniques, tragedies
from underlying metabolic derangements will still happen from more factors than anyone
can image. Whether it be a gap or dislocation in medical care, a disruptive culture, or
simply a decline in lifestyle for various reasons, the causes are not simple. The data
today shows, as metabolisms slow when one begins to age, high body fat percentage bordering
on obesity, a decreased volume of total body water and atrophy of skeletal muscle, is almost
inevitable for a majority of people as they enter into elderhood. But that doesn’t mean
to ignore your health when you are young either. With continued monitoring in the ICU, counseling
and social support to bring CJ back from the brink, and a new hope to regain status in
his life once again CJ was able to make a full recovery. Thank you so much for watching. Take care
of yourself. And Be well.

100 Replies to “A Dad Didn’t Brush His Teeth For 40 Days. This Is What Happened To His Kidneys.”

  1. So my takeaway is that as long as I can go 40 days without brushing my teeth and survive that means I'm not the father? Who needs Maury?!

  2. This is rubbish isn't it – surely toothbrushes and toothpaste are relatively new inventions. For millions of years people didn't brush their teeth – were they keeling over all the time. I somehow. doubt it…geez

  3. What happens when the dentist leaves decay on the teeth to make sure you return for more treatment ensuring his/her profession?
    Sad to day this does happen. Alot of internal problems are caused by bad teeth.
    A dentist in Preston near Worthing UK. Imagine dental surgery did such a thing. He was only one of a few dental surgeons.

  4. This is why when you're thirsty, drink fucking WATER. People need to stop chugging juice or fizzy drinks all the time. There's too much sugar in them. Your body doesn't need all that sugar, it will only overload and strain your system.

  5. Damn, this dude's life sounds like a country and western song. I mean, except for the part where he starts pigging out. If this were a C&W song, he would rotted his liver out with Old Crow.

  6. I haven't brushed my teeth for 6 months now. When I went to the dentist, my teeth were fine, but there just was alot of plaque buildup. stop lying emu


    TIRKKCOQPVXLWNFFB eh never mind I was confused at first

  8. I almost died from infected teeth I lost my bones in my right femar,hip joint ball,an part of my pelvis aswell an I'm still with out them today in pain everytime I walk

  9. My mother had an unknown infection in her jaw due to shitty dentists messing her teeth up and her own anxiety which caused her to not go to see anyone for her tooth problems for like 20 years. When she did, her entire jaw had to be re-done and every tooth pulled – doctors told us that she could have easily died due to the puss in her jaw that could spontaniously cause heart attacks and worse. Take care of your teeth everyone.

  10. >5 year old son dies
    >laid off
    >wife leaves you
    >rest of your family dies
    >go into poverty
    >gain 250 pounds
    >kidneys fail
    >type 2 diabetes

    bad rng man.. bad rng

  11. Odd. When I went into chemo treatment they told me never to brush mine because I might not stop bleeding. Got lucky I guess.

  12. how are you able to share people’s medical information? you show up at their death bed and ask if they wanna be on youtube? or some type of medical journalist or something?

  13. All the crab he said is just called diabetes type 2.
    Believe me I understand this very well.
    And I really skeptical about the tooth infection, I think it is a normal infection from a food he ate.

  14. I read all the comments and laughed extremely hard. Let’s see what happened to my stomach musc…

    Glucose decency
    Septic blood
    Liver failure
    Brain death

    I died

  15. There’s only one problem when you talked about fats they are good for you they have the least insulin resistance proteins have the second least and carbs/sugar have the most

  16. Meta data for those who talk about animal insulin no longer being available even though its cheaper, go to 11:18 where the long term usage negative effects are discussed

  17. Sigh all these children trying to be funny in the comments. Meanwhile im just looking for medical discussion of anyone who has something interesting to share that relates. Ill keep looking i guess.

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