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User:りょう ゆそう/A TikToker Drank 2 Bottles Benadryl. This Is What Happened To Her Organs. (查看源代码)
2020年9月18日 (五) 20:20的版本
、 2020年9月18日 (五) 20:20创建页面，内容为“{{医学声明}} *本视频在2020年9月16日投稿至[https://youtube.com/watch?v=NaAFOrudj0g 油管] *本文主要记述了一名TikToker为了博取关注，一…”
{{医学声明}}
*本视频在2020年9月16日投稿至[https://youtube.com/watch?v=NaAFOrudj0g 油管]
*本文主要记述了一名TikToker为了博取关注，一次性饮用了两大瓶苯海拉明后，她的器官的衰竭和治疗过程。
<center><img src="https://pbs.twimg.com/media/EiEdg4YWkAElKtw?format=jpg&name=small" style="height:300px;" /></center>
==正文区==
{{Lyrics
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<big><big><big>H</big></big></big>i, Doctor Bernard here.Don’t do this.
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Just because Benadryl is over the counter doesn’t mean it can’t do bad things.Even taking it as directed for allergies,often nets people a dullness and mental fog that lasts in to the next day.
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DON’T DO IT!!!
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<big><big><big>嗨</big></big></big>！来自Bernard医生的忠告：“千万不要这样做！”
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尽管苯海拉明是非处方药，但是这并不意味着它就百利而无一害。甚至是针对过敏反应的治疗按方服用，也常常会让人感到眩晕和精神迟钝，并且这种感觉会持续到第二天。
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'''千 万 不 要 这 样 做！！！'''
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JC is a 21 year old woman, presenting to the emergency room, unconscious.
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Her dad Scott, tells the admitting nurse that she had at least 3 seizures in the past hour.The last one went on for more than 15 minutes, before he saw his daughter fall limp likea rag doll.
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You see, JC was a regular college student in 2020.She just finished her finals, although, she had already moved back home earlier that spring,because of pandemic.This summertime break, was a good chance for her to pump up her internet following.With TikTok being the favorite of all her friends, she was going to become internetfamous.
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A small trend was growing over the weekend.This is going to be something big, she thought.
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JC是一位21岁的女性，因昏迷送入急诊室。
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她的爸爸Scott告诉入院护士，她过去一小时内至少有3次癫痫发作，最后一次持续了超过15分钟，直到他看到他的女儿像一个布娃娃一样软弱无力，瘫倒在地。
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如你所见，JC是在2020年的时候，还是一名普通的大学生。尽管她刚刚完成期末考试，但是由于疫情流行的影响，今年春天的早些时候她已经搬回家了。这个暑假对她来说正是一个涨粉的大好时机。适逢TikTok在她所有朋友中广为流行，借此机会，她将会成为知名网红。
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“这周末的粉丝数量有小幅上升趋势。这将会是一件大事“。她想。
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Back when she still had classes in person,she heard about Benadryl being able to “open someone’s mind.”Some of her friends tried it on the weekends.She thought she had tried it during her freshman year, but couldn’t remember. She couldn’t really remember anything from that year.
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Haha TikTok meme she thought this time around,as she danced around on camera with 2 whole bottles of Benadryl, before dumping them into her mouth.
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当她还在上课的时候，她听说苯海拉明能够“打开一个人的心灵”。她的一些朋友已经在周末尝试过了，她以为自己在大一的时候也试过，但不记得了。她是真的不记得那年发生的事情了{{黑幕|这大学也算是白念了}}。
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此时，她想到了TikTok上的那些搞笑的模因。于是她便拿着两瓶苯海拉明在镜头前跳舞，然后就把它们倒进了嘴里吨吨吨了。
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And immediately after finishing both bottles, JC didn’t really feel anything.She was going to be famous now.She was going to get 10 million views.“Allergy medicine go glug glug” she thought.
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And what she didn’t realize is that the dose of both bottles combined, can be fatal. As the hour passed, JC could feel a burning sensation at the base of her neck.Her ceiling became like jello,wobbling around.But ceilings are cringe.and floor gang now, she thought.Always have been.
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JC had never felt more relaxed, as she turned on some music.She could hear people chanting her name over the speakers.That’s the sound of being TikTok famous, she thought.She tried recording more videos of her trip,but eventually she forgot what she was doing.Her vision was blurry, but she didn’t need her eyes to see anymore.There was a drum beating faster and faster in her chest.Her mouth was like a desert, devoid of water, and her teeth were giant stones, grindingeach other down into sand.
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JC looked at the clock 12 hours had passed.Her dad had come up to her and asked, “how many Benadryl did you drink?”But she wasn’t sure if that was a hallucination or not.She said she took 10 million, which is how many TikTok views she’d get, as she suffers her first seizure.In reality, no one was around.Her dad hadn’t seen JC since hours before she took the Benadryl, as she falls unconscious on the floor.As Scott walks in on his daughter, he sees her suffer her third seizure.
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While he called 911, and while the ambulance was on its way, JC’s seizure wouldn’t stop.But when paramedics arrived, she fell limp.Her dad had no idea what happened as she arrives to the emergency room, where we are now.
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在刚喝完两瓶苯海拉明后，JC就没有什么知觉了。她只知道自己即将出名。她将会收获千万播放量。她想：“两大瓶抗过敏药被我吨吨吨啦！”
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但是她没有意识到一次性饮用下两瓶药的量将会是致命的。一小时过去了，JC感到脖子底部有灼烧感。她看到天花板变得像果冻一样，摇摇晃晃。啊！现在地板也开始摇晃了！她正想着，却长时间都是如此精神迟钝的状态。
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当她打开音乐时，JC感到前所未有的放松。她能听到人们对着喇叭喊她的名字。这就是成为TikTok网红的声音，她想。她想试着录下更多关于她旅行的视频，但是最终她还是忘记了自己正在做什么。她的视力渐渐模糊了，但她不再需要她的眼睛去看什么东西了。似乎正有人在她的胸腔内打鼓，越来越响。她的口干得像缺水的沙漠，牙齿则是巨大的石头，互相碾磨，磨成沙粒。
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JC看了看时钟，12个小时过去了。她爸爸走到她面前问:“你喝了多少苯海拉明？”但是她不能确定这不是不她的幻觉。她说：“得有1000万。”这是她第一次癫痫发作时，她的TikTok视频的点击量。事实上，她的周围并没有人。在她喝下用苯海拉明之前，她的父亲已经有几个小时没见过JC了，当时她正倒在地板上失去了知觉。当Scott走进他的女儿时，他看到她的第三次癫痫发作。
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他拨打了911，救护车也赶来的路上，但是JC的癫痫一直没有停止。当医护人员赶到时，她无力地瘫倒了下来。当她被送到到达急救室时，也就是我们现在所在的地方，她爸爸并不知道她到底发生了什么。
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At examination, JC was unresponsive.She was flushed, but she didn’t have a fever.Her heart rate was 180 beats per minute, about3 times more than normal, but her blood pressure was 70 over 40, about half of normal.No one there had any idea that JC had taken a whole bottle of Benadryl, but there’s a few clues as to what could be happening.
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JC’s skin was red, but she wasn’t sweating.Her pupils were dilated, and were minimally reactive to light.Her mouth was dry, just like all her mucous membranes.Her heart was beating fast.All of this together, signals anticholinergic poisoning.
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在检查时，JC仍然没有意识。她的脸发红，但是她并没有发烧。她的心率是每分钟180次，大约是正常人的3倍，但是她的血压是每分钟70~40，大约是正常人的一半。没有人知道JC服用了一整瓶的苯海拉明，但是对于可能发生的事情还是有一些线索。
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JC的皮肤是泛红，但她没有出汗。她的瞳孔扩大了，但是瞳孔对光反射消失。她的嘴很干，就像她所有的粘膜一样。她的心跳得很快。所有这些线索都指向了抗胆碱能药物中毒。
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-But what does that mean?
-What is a cholinergic?
-And what does it have to do with Benadryl?
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Well, Benadryl is an allergy medicine.Its chemical name is diphenhydramine.Lots of people take it in the spring, when flowers are blooming.Pollen and allergens cause people to sneeze.To cough.To have a runny and stuffed nose.The body thinks these allergens are foreign objects that need to be removed.What’s a good way to remove things?Well you could dilate the blood vessels, and make them more leaky, in the hopes that the allergens will leak out.
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Benadryl stops this allergic reaction by stopping the signal for it, which is from a natural chemical that’s made in your body, called '''Histamine'''.'''Hist-''' from histidine, which is an amino acid, a building block of proteins in your body,and '''Amine''' referring to nitrogen which is a base word for amino acid.
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-But if Benadryl is just an over the counter allergy medicine, why did it cause JC to hallucinate?
It’s not like you’re stopping allergies in the brain!
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-And why is her heart beating so fast?
As the doctors keep examining her, they find she has a pulse, but her heart is beating in a way, that if nothing is done about it, her heart will just shake in place, and won’t be able to produce an actual contraction.
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-但是，这又是什么意思呢？
-什么是胆碱能？
-它和苯海拉明有什么关系？
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苯那君是一种抗过敏药，它的化学名称是苯海拉明。很多人会在春天花开的季节服用。因为花粉会成为过敏原，导致人们打喷嚏、咳嗽、流鼻涕和鼻塞。人体认为这些过敏原是需要被人体清除的异物。那么如何移除它们呢？那么，扩张血管，使它们更容易渗漏，这样过敏原就会渗出来。
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苯海拉明则通过阻断过敏信号来阻止过敏反应，这种信号来自一种你体内产生的叫做“'''组胺'''”的天然化学物质。“Hist-”意思是来自组氨酸，组氨酸是一种氨基酸，是你体内蛋白质的组成部分之一，“Amine”指的是氮，氮是组成氨基酸的基础原料。
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-但如果苯那君只是一种非处方的抗过敏药，那么为什么它能导致JC产生幻觉呢?
这并不意味着你正在阻止大脑发生过敏反应！
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-那为什么她的心跳这么快?
通过医生对她的检查，他们发现她有还脉搏，但是她的心脏在某种低水平的程度上颤动着，如果不采取任何措施，她的心脏只会原地颤动，并不会产生真正的收缩。
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Doctors shock her in to a normal heart rhythm.And after this happens, JC’s dad realizes his daughter had posted some TikTok videos of her drinking 2 whole bottles of diphenhydramine.He shows this to the doctors, and it tells them everything that they need to know.
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Diphenhydramine inactivates histamine receptors.It doesn’t stop the immune system from releasing histamine, it stops your body from interacting with it.When you take the dose on the instructions for allergies, this inactivates enough of the histamine receptors, so that you don’t have a reaction.But if someone takes too much, like lets say a '''2 WHOLE BOTTLES''', then that person is going to have a lot of diphenhydramine floating around in the body, meaning it’s going to interact with more than just histamine receptors.
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医生通过电击终于使她恢复正常心律。在这之后，JC的父亲突然意识到，关于他的女儿喝了整整两瓶苯海拉明这件事，她曾经上传的一些TikTok视频。他把这些视频给医生看，并且终于了解了他们需要了解的一切事情的起因。
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苯海拉明的作用是使组胺受体失活。它并不会阻止免疫系统释放组胺，从而阻止你的身体与组胺互动。当你按照指示服用剂量时用于抗过敏时，苯海拉明就会使组胺受体失去活性，这样你就不会产生过敏反应。但如果一个人服用过量，比如'''整整两瓶'''，那么这个人体内就会漂浮着过量的游离的苯海拉明，这意味着苯海拉明不仅仅只与组胺受体相互作用。
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-But, what else would that be?
Well, if you’ve ever taken diphenhydramine,you know it can make you sleepy.That’s why it’s branded as a sleep aid too.Some parents give it to their kids before a flight so that the kid will sleep on the plane and not cause a ruckus.'''You shouldn’t do that to your kids'''.
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But if you’ve ever taken it for sleep, you know you don’t wake up feeling great.All of this means that Benadryl acts on the brain.Which is clearly what it did to JC because as doctors transfer her into the intensive care unit, she suffers her fourth seizure.
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-那么，这些苯海拉明会到哪里去呢?
如果你曾服用过苯海拉明，你就会知道它能让你昏昏欲睡。这就是为什么它也被常常用于助眠。有些家长会在飞机起飞前给孩子服用，这样熊孩子们就只能在飞机上乖乖睡觉，而不是大吵大闹。'''但是，你不应该这样对你的孩子！！！'''
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但是如果你曾经为了入眠而服用过它，你就会知道，当你醒来时，你其实并不会感到很舒服。这一切事情都意味着，苯海拉明会对大脑起作用。JC显然就是这样，因为当医生把她转到重症监护室时，她的第四次癫痫发作了。
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Nurses had to give medicine to stop the seizure, because it wouldn’t stop on its own.The Benadryl deposits not just in her brain, but in all her organs because she took so much of it.This brings us to an idea called '''Lipophilicty'''.'''Lipo-''' meaning fat and '''Philic''' meaning affinity for.
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Benadryl is lipophilic, meaning it dissolves in fat.We know that water doesn’t mix well with oil, which is a fat.Outside of the cells in the human body, there’s a bilipid layer, meaning your cells are coated and defined by a layer of fat.This would mean that a lot of Benadryl doesn’t want to be in the blood, because blood is mostly made of water— it would want to be in the cells, so it can interact with that bilipid layer.And, more than 60% of the brain is made of fat, which is how Benadryl would get in.
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护士们不得不给药来阻止JC的癫痫发作，因为它无法自己停止。因为她摄取了太多苯海拉明，所以不仅在她的大脑中，还在在她的所有器官中，都聚集着大量的苯海拉明。这给我们带来了一个叫做“'''亲脂性'''”的概念。“'''Lipo-'''”的意思是脂肪，“'''Philic'''”的意思是亲和力。
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苯海拉明是亲脂性的，也就是说，它可以溶解在脂肪中。我们都知道，水和油并不互溶，因为油是一种脂肪。在人体细胞的外层是一层脂质层，这意味着你的细胞被一层脂肪包裹着。这意味着大量的苯海拉明不容易存在于血液中，因为血液主要是由水构成的——它更容易存在于细胞中，这样它就可以与胆脂层相互作用。而且，大脑是的组成成分中，超过60%是脂肪，这就是为什么苯海拉明会在大脑中大量聚集。
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Do you remember those histamine receptors? Well they’re not just in the lungs and the skin to cause an allergic reaction.They’re also in the brain.And while histamine can cause blood vessels to dilate and become leaky elsewhere in the body, in the brain it does different things.It regulates sleep and wakefulness, so if Benadryl is there, cells don’t respond to histamine anymore, so there’s no more regulation, and no more wakefulness.That’s how it causes drowsiness.
Histamine’s also involved in cognition.So if Benadryl is there to block it, then there’s less cognition.Less cognition could mean more hallucinations, which sounds a lot like JC’s case.Histamine also has anticonvulsant activity, so if Benadryl is there to inactivate it, then there would be convulsant activity, explaining her seizures.
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But she doesn’t just have a little bit of Benadryl in her body, she has 2 whole bottles of it.But if it’s sitting in her organs, blocking all the histamine receptors, and there’s still a lot of it floating around, what else would it block?
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This brings us back to “'''anticholinergic poisoning'''”.
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你还记得那些组胺受体吗?它们不只是在肺和皮肤中引起过敏反应。它们同样也存在于大脑中。虽然组胺能导致身体其他部位的血管扩张和渗漏，但它在大脑中却有着不同的作用。它会调节你的睡意和清醒状态。如果大脑中聚集有苯海拉明，脑细胞就不会再对组胺做出反应，所以就不能调节睡眠状态状态，也难以再清醒。这就是它引起睡意的原因。组胺也与认知有关。如果苯海拉明阻止了组胺的作用，那么认知就会减弱。更弱的认知就意味着更强的幻觉，正如JC的案例一样。组胺同样也有抗惊厥活性，如果有苯海拉明来灭活组胺，那么抗惊厥活性就失效了，这就解释了她癫痫发作的原因。
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但她体内并不是只有一点点苯海拉明，而是整整两瓶。但如果苯海拉明在她的器官中，已经阻断了所有的组胺受体，而且还有大量的组胺在各处游离，那么，它还会破坏什么?
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这让我们回到“'''抗胆碱能中毒'''”这个概念上来。
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A “cholinergic” refers to the naturally occurring chemical called choline.Which happens to have a similar structure to Benadryl.One part of your nervous system signals for “rest and digest”.This is mediated by the chemical acetylcholine, which is made inside your body.And cholinergic receptors, take in acetylcholine to promote “rest and digest.”But interestingly enough, since we have sequenced the entire human genome, we know what the DNA in our body makes.Nature likes to conserve things, and our genome tells us that almost half of this cholinergic receptor, is just like the histamine receptor.And because Benadryl isn’t too different in structure from choline, then it means having a massive amount of Benadryl in the body, would cause it to bind to cholinergic receptors too.A lot of Benadryl means a lot of these cholinergic receptors don’t get acetylcholine anymore, they get Benadryl instead, meaning, JC’s body can’t signal “rest and digest” either.
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“胆碱能”指的是一种被称为胆碱的天然化学物质。它和苯海拉明的结构很相似。你的部分神经系统会发出“休息和消化”的信号。这是由你体内产生的化学物质乙酰胆碱所介导的。胆碱能受体，通过与乙酰胆碱结合，从而身体促进“休息和消化”。“但有趣的是，既然我们已经完成了整个人类基因组的排序，那我们就知道我们体内的DNA会产生什么。”大自然总是喜欢有所保留，我们的基因组告诉我们，几乎一半的胆碱能受体，就像组胺受体一样（容易被苯海拉明灭活）。因为苯海拉明在化学结构上与胆碱没有太大区别，这也意味着体内有过量的苯海拉明会与胆碱能受体结合。大量的苯海拉明灭活了胆碱能受体，意味着很多胆碱能受体无法得到正确的信号分子——乙酰胆碱，而是得到苯海拉明，也意味着JC的身体也不能发出"休息和消化"的信号。
|lb-text32=
Without a digest signal, her mouth becomes dry so no more saliva.Her stomach muscles don’t move anymore.She becomes flushed, but can’t sweat.She can’t and hasn’t urinated since she took the whole bottle of Benadryl.Her pupils become dilated.And her heart doesn’t slow down, it speeds up to the point where it shakes in place and doesn’t actually produce a real contraction.
|lb-text33=
In the intensive care unit, doctors give medicines to try and stabilize her heart rhythm.Benadryl doesnt just stop the histamine signal, it doesn’t JUST stop the rest and digest signal.It also blocks sodium going in to heart muscle cells because the other part of its shape happens to fit in those receptors in the heart too.And because JC took a huge amount of it, there’s enough extra floating around to block anything where it can fit.
|rb-text32=
因为没有消化信号，所以就不再分泌唾液，她的嘴就会变干。她的腹部肌群也不再运动了。她的脸颊泛红，但没有出汗。而且自从她喝下了整瓶的苯海拉明后，她不能，也无法正常排尿。她的瞳孔放大。但她的心脏并没有减速，而只是加速颤抖，并没有产生真正的收缩。
|rb-text33=
在重症监护室，医生通过给药来试图稳定她的心律。因为苯海拉明不只是阻断组胺信号，也不只是阻断休息和消化信号。它还阻断钠进入心肌细胞，因为它的另一部分碰巧也适合心脏中的受体形状相吻合。正因为JC摄入了过量的苯海拉明，所以也有足够多的额外游离的苯海拉明来阻断任何的东西，从而使她心律失常。
|lb-text34=
Is there any way we could happen to pull it out of her organs?
Well, maybe. But in most cases, this is treated by... waiting it out.
|lb-text35=
Give medicines to stabilize her heart.
Give medicines to stop her seizures if they happen.
Ventilate her so that a machine breathes for her because she can’t do it on her own.
But maybe, there is a way we can exploit the chemical property of Benadryl to treat her.
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Bringing us back to lipophilicity.If Benadryl dissolves in fat, but not water, could we somehow infuse fat into her veins in the hopes that it would pull out Benadryl from her organs?
At this thought, doctors infused the lipid emulsion used to feed critically ill patients, intravenously.JC’s heart rhythm didn’t change after the first infusion. It’s still unstable.Twenty minutes later, doctors infuse another bolus in, and then, her heart stabilizes, and throughout the duration of her stay in the hospital, she never has another abnormal heart rhythm.
|lb-text37=
In several case reports of this intravenous lipid emulsion therapy for various toxicities,a positive inotropy was observed, meaning after infusion of fat emulsion, the heart beats harder and stronger.It’s possible that it could be the heart muscle changing energy source from glucose to fatty acid from the emulsion.
|lb-text38=
But it could also be additional volume in the blood stretching the heart and causing a rebound reflex.Or it could just be because the toxicity has been reversed.That’s the good part. Sometimes, that bolus of fat can cause pancreatitis, cause the pancreas is supposed to help break down fats, and it can also cause acute respiratory distress, that would be the bad part.
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But in this case, JC turned out OK.And on day 3 of hospitalization, she pulled out the tube that was down her throat.Confused as to where she was, her dad explained to her everything that happened, as she realized that the TikTok fame wasn’t worth the memes, especially since she felt a mental fog and haze from the event, for several months afterwards.
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有没有办法能把这些苯海拉明从她的器官里排出来呢?
嗯,也许吧。但在大多数情况下，便是……等待它自己排出来。
|rb-text35=
给她注射用来稳定心率的药物。如果癫痫发作，则给她注射抗癫痫药物。因为她不能自主呼吸，所以给她通气管，并让呼吸机机器替她的自主呼吸。但也许，我们可以利用苯海拉明的化学性质来治疗她。
|rb-text36=
回到亲油性上来。如果苯海拉明更容易溶解在脂肪里，而不是水里，我们能不能用某种方法把脂肪注入她的静脉，来尝试把苯海拉明从她的器官里排出来？有了这个想法后，医生们将用于喂养危重病人的脂质乳剂静脉注射进去。JC的心率在第一次注射后没有变化。它仍然是不稳定的。20分钟后，医生又给她注射了一剂，终于，她的心脏稳定了下来，在她住院期间，她的心律再也没有出现过异常。
|rb-text37=
在一些病例报告中，血脂乳状液治疗多种毒副反应均呈正性肌力，即脂肪乳状液注射后心脏跳动更强。有可能是心肌细胞将能量来源从葡萄糖转变为乳剂中的脂肪酸。
|rb-text38=
但这种方法会增加血液中额外的容量，扩展心脏，引起心血管的减压反射。往好的方向来说，它可能会让毒性已经逆转。往糟糕的方向来说，有时候，那一团脂肪会引发胰腺炎，因为胰腺应该帮助身体分解这些大量的脂肪，同时它也会引起急性呼吸窘迫。
|rb-text39=
尽管如此，JC的最终结果是好的。在住院治疗的第三天，她拔掉了喉管。父亲向不知道自己身在何处的她解释了发生的一切，她意识到TikTok的名气并不不值得，尤其是在这件事之后的几个月，她一直感到精神恍惚。
|lb-text40=
Viral following is almost never worth it.Because fast up is fast down.Brightest stars burn out the fastest.
|lb-text41=
Thanks so much for watching, take care of yourself, and be well.
|rb-text40=
博取病毒式的跟风关注从来都是不值得尝试的。恰似海上的浪潮一样，腾涌而起后必定会狠狠地摔落。要知道，最闪耀的恒星也衰竭得最迅速。
|rb-text41=
非常感谢您的观看，照顾好自己，并祝你身体健康。
}}
== 笔记 ==
'''Benadryl''',系统命名法:2-(diphenylmethoxy)-N,N-dimethylethanamine
<img src="https://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Diphenhydramine_2D_skeletal.svg/440px-Diphenhydramine_2D_skeletal.svg.png" style="height:90px;" />
国内通常翻译为'''苯那君'''、'''苯海拉明'''。
苯海拉明是一种抗组胺药，是'''第一代的H1拮抗剂'''，会阻断一些组织胺的作用，所以可以用来治疗过敏性皮肤黏膜疾病。
也可以用于治疗失眠、感冒症状、帕金森氏症震颤和恶心（但是作用机制不清楚）。
苯海拉明常见的副作用包括嗜睡、方向感不佳以及反胃，不建议给婴儿服用。目前还不清楚在怀孕时使用的风险，不过不建议在哺乳时服用此药物。
*本视频在2020年9月16日投稿至[https://youtube.com/watch?v=NaAFOrudj0g 油管]
*本文主要记述了一名TikToker为了博取关注，一次性饮用了两大瓶苯海拉明后，她的器官的衰竭和治疗过程。
<center><img src="https://pbs.twimg.com/media/EiEdg4YWkAElKtw?format=jpg&name=small" style="height:300px;" /></center>
==正文区==
{{Lyrics
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<big><big><big>H</big></big></big>i, Doctor Bernard here.Don’t do this.
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Just because Benadryl is over the counter doesn’t mean it can’t do bad things.Even taking it as directed for allergies,often nets people a dullness and mental fog that lasts in to the next day.
|lb-text3=
DON’T DO IT!!!
|rb-text1=
<big><big><big>嗨</big></big></big>！来自Bernard医生的忠告：“千万不要这样做！”
|rb-text2=
尽管苯海拉明是非处方药，但是这并不意味着它就百利而无一害。甚至是针对过敏反应的治疗按方服用，也常常会让人感到眩晕和精神迟钝，并且这种感觉会持续到第二天。
|rb-text3=
'''千 万 不 要 这 样 做！！！'''
|lb-text4=
JC is a 21 year old woman, presenting to the emergency room, unconscious.
|lb-text5=
Her dad Scott, tells the admitting nurse that she had at least 3 seizures in the past hour.The last one went on for more than 15 minutes, before he saw his daughter fall limp likea rag doll.
|lb-text6=
You see, JC was a regular college student in 2020.She just finished her finals, although, she had already moved back home earlier that spring,because of pandemic.This summertime break, was a good chance for her to pump up her internet following.With TikTok being the favorite of all her friends, she was going to become internetfamous.
|lb-text7=
A small trend was growing over the weekend.This is going to be something big, she thought.
|rb-text4=
JC是一位21岁的女性，因昏迷送入急诊室。
|rb-text5=
她的爸爸Scott告诉入院护士，她过去一小时内至少有3次癫痫发作，最后一次持续了超过15分钟，直到他看到他的女儿像一个布娃娃一样软弱无力，瘫倒在地。
|rb-text6=
如你所见，JC是在2020年的时候，还是一名普通的大学生。尽管她刚刚完成期末考试，但是由于疫情流行的影响，今年春天的早些时候她已经搬回家了。这个暑假对她来说正是一个涨粉的大好时机。适逢TikTok在她所有朋友中广为流行，借此机会，她将会成为知名网红。
|rb-text7=
“这周末的粉丝数量有小幅上升趋势。这将会是一件大事“。她想。
|lb-text8=
Back when she still had classes in person,she heard about Benadryl being able to “open someone’s mind.”Some of her friends tried it on the weekends.She thought she had tried it during her freshman year, but couldn’t remember. She couldn’t really remember anything from that year.
|lb-text9=
Haha TikTok meme she thought this time around,as she danced around on camera with 2 whole bottles of Benadryl, before dumping them into her mouth.
|rb-text8=
当她还在上课的时候，她听说苯海拉明能够“打开一个人的心灵”。她的一些朋友已经在周末尝试过了，她以为自己在大一的时候也试过，但不记得了。她是真的不记得那年发生的事情了{{黑幕|这大学也算是白念了}}。
|rb-text9=
此时，她想到了TikTok上的那些搞笑的模因。于是她便拿着两瓶苯海拉明在镜头前跳舞，然后就把它们倒进了嘴里吨吨吨了。
|lb-text10=
And immediately after finishing both bottles, JC didn’t really feel anything.She was going to be famous now.She was going to get 10 million views.“Allergy medicine go glug glug” she thought.
|lb-text11=
And what she didn’t realize is that the dose of both bottles combined, can be fatal. As the hour passed, JC could feel a burning sensation at the base of her neck.Her ceiling became like jello,wobbling around.But ceilings are cringe.and floor gang now, she thought.Always have been.
|lb-text12=
JC had never felt more relaxed, as she turned on some music.She could hear people chanting her name over the speakers.That’s the sound of being TikTok famous, she thought.She tried recording more videos of her trip,but eventually she forgot what she was doing.Her vision was blurry, but she didn’t need her eyes to see anymore.There was a drum beating faster and faster in her chest.Her mouth was like a desert, devoid of water, and her teeth were giant stones, grindingeach other down into sand.
|lb-text13=
JC looked at the clock 12 hours had passed.Her dad had come up to her and asked, “how many Benadryl did you drink?”But she wasn’t sure if that was a hallucination or not.She said she took 10 million, which is how many TikTok views she’d get, as she suffers her first seizure.In reality, no one was around.Her dad hadn’t seen JC since hours before she took the Benadryl, as she falls unconscious on the floor.As Scott walks in on his daughter, he sees her suffer her third seizure.
|lb-text14=
While he called 911, and while the ambulance was on its way, JC’s seizure wouldn’t stop.But when paramedics arrived, she fell limp.Her dad had no idea what happened as she arrives to the emergency room, where we are now.
|rb-text10=
在刚喝完两瓶苯海拉明后，JC就没有什么知觉了。她只知道自己即将出名。她将会收获千万播放量。她想：“两大瓶抗过敏药被我吨吨吨啦！”
|rb-text11=
但是她没有意识到一次性饮用下两瓶药的量将会是致命的。一小时过去了，JC感到脖子底部有灼烧感。她看到天花板变得像果冻一样，摇摇晃晃。啊！现在地板也开始摇晃了！她正想着，却长时间都是如此精神迟钝的状态。
|rb-text12=
当她打开音乐时，JC感到前所未有的放松。她能听到人们对着喇叭喊她的名字。这就是成为TikTok网红的声音，她想。她想试着录下更多关于她旅行的视频，但是最终她还是忘记了自己正在做什么。她的视力渐渐模糊了，但她不再需要她的眼睛去看什么东西了。似乎正有人在她的胸腔内打鼓，越来越响。她的口干得像缺水的沙漠，牙齿则是巨大的石头，互相碾磨，磨成沙粒。
|rb-text13=
JC看了看时钟，12个小时过去了。她爸爸走到她面前问:“你喝了多少苯海拉明？”但是她不能确定这不是不她的幻觉。她说：“得有1000万。”这是她第一次癫痫发作时，她的TikTok视频的点击量。事实上，她的周围并没有人。在她喝下用苯海拉明之前，她的父亲已经有几个小时没见过JC了，当时她正倒在地板上失去了知觉。当Scott走进他的女儿时，他看到她的第三次癫痫发作。
|rb-text14=
他拨打了911，救护车也赶来的路上，但是JC的癫痫一直没有停止。当医护人员赶到时，她无力地瘫倒了下来。当她被送到到达急救室时，也就是我们现在所在的地方，她爸爸并不知道她到底发生了什么。
|lb-text15=
At examination, JC was unresponsive.She was flushed, but she didn’t have a fever.Her heart rate was 180 beats per minute, about3 times more than normal, but her blood pressure was 70 over 40, about half of normal.No one there had any idea that JC had taken a whole bottle of Benadryl, but there’s a few clues as to what could be happening.
|lb-text16=
JC’s skin was red, but she wasn’t sweating.Her pupils were dilated, and were minimally reactive to light.Her mouth was dry, just like all her mucous membranes.Her heart was beating fast.All of this together, signals anticholinergic poisoning.
|rb-text15=
在检查时，JC仍然没有意识。她的脸发红，但是她并没有发烧。她的心率是每分钟180次，大约是正常人的3倍，但是她的血压是每分钟70~40，大约是正常人的一半。没有人知道JC服用了一整瓶的苯海拉明，但是对于可能发生的事情还是有一些线索。
|rb-text16=
JC的皮肤是泛红，但她没有出汗。她的瞳孔扩大了，但是瞳孔对光反射消失。她的嘴很干，就像她所有的粘膜一样。她的心跳得很快。所有这些线索都指向了抗胆碱能药物中毒。
|lb-text17=
-But what does that mean?
-What is a cholinergic?
-And what does it have to do with Benadryl?
|lb-text18=
Well, Benadryl is an allergy medicine.Its chemical name is diphenhydramine.Lots of people take it in the spring, when flowers are blooming.Pollen and allergens cause people to sneeze.To cough.To have a runny and stuffed nose.The body thinks these allergens are foreign objects that need to be removed.What’s a good way to remove things?Well you could dilate the blood vessels, and make them more leaky, in the hopes that the allergens will leak out.
|lb-text19=
Benadryl stops this allergic reaction by stopping the signal for it, which is from a natural chemical that’s made in your body, called '''Histamine'''.'''Hist-''' from histidine, which is an amino acid, a building block of proteins in your body,and '''Amine''' referring to nitrogen which is a base word for amino acid.
|lb-text20=
-But if Benadryl is just an over the counter allergy medicine, why did it cause JC to hallucinate?
It’s not like you’re stopping allergies in the brain!
|lb-text21=
-And why is her heart beating so fast?
As the doctors keep examining her, they find she has a pulse, but her heart is beating in a way, that if nothing is done about it, her heart will just shake in place, and won’t be able to produce an actual contraction.
|rb-text17=
-但是，这又是什么意思呢？
-什么是胆碱能？
-它和苯海拉明有什么关系？
|rb-text18=
苯那君是一种抗过敏药，它的化学名称是苯海拉明。很多人会在春天花开的季节服用。因为花粉会成为过敏原，导致人们打喷嚏、咳嗽、流鼻涕和鼻塞。人体认为这些过敏原是需要被人体清除的异物。那么如何移除它们呢？那么，扩张血管，使它们更容易渗漏，这样过敏原就会渗出来。
|rb-text19=
苯海拉明则通过阻断过敏信号来阻止过敏反应，这种信号来自一种你体内产生的叫做“'''组胺'''”的天然化学物质。“Hist-”意思是来自组氨酸，组氨酸是一种氨基酸，是你体内蛋白质的组成部分之一，“Amine”指的是氮，氮是组成氨基酸的基础原料。
|rb-text20=
-但如果苯那君只是一种非处方的抗过敏药，那么为什么它能导致JC产生幻觉呢?
这并不意味着你正在阻止大脑发生过敏反应！
|rb-text21=
-那为什么她的心跳这么快?
通过医生对她的检查，他们发现她有还脉搏，但是她的心脏在某种低水平的程度上颤动着，如果不采取任何措施，她的心脏只会原地颤动，并不会产生真正的收缩。
|lb-text22=
Doctors shock her in to a normal heart rhythm.And after this happens, JC’s dad realizes his daughter had posted some TikTok videos of her drinking 2 whole bottles of diphenhydramine.He shows this to the doctors, and it tells them everything that they need to know.
|lb-text23=
Diphenhydramine inactivates histamine receptors.It doesn’t stop the immune system from releasing histamine, it stops your body from interacting with it.When you take the dose on the instructions for allergies, this inactivates enough of the histamine receptors, so that you don’t have a reaction.But if someone takes too much, like lets say a '''2 WHOLE BOTTLES''', then that person is going to have a lot of diphenhydramine floating around in the body, meaning it’s going to interact with more than just histamine receptors.
|rb-text22=
医生通过电击终于使她恢复正常心律。在这之后，JC的父亲突然意识到，关于他的女儿喝了整整两瓶苯海拉明这件事，她曾经上传的一些TikTok视频。他把这些视频给医生看，并且终于了解了他们需要了解的一切事情的起因。
|rb-text23=
苯海拉明的作用是使组胺受体失活。它并不会阻止免疫系统释放组胺，从而阻止你的身体与组胺互动。当你按照指示服用剂量时用于抗过敏时，苯海拉明就会使组胺受体失去活性，这样你就不会产生过敏反应。但如果一个人服用过量，比如'''整整两瓶'''，那么这个人体内就会漂浮着过量的游离的苯海拉明，这意味着苯海拉明不仅仅只与组胺受体相互作用。
|lb-text24=
-But, what else would that be?
Well, if you’ve ever taken diphenhydramine,you know it can make you sleepy.That’s why it’s branded as a sleep aid too.Some parents give it to their kids before a flight so that the kid will sleep on the plane and not cause a ruckus.'''You shouldn’t do that to your kids'''.
|lb-text25=
But if you’ve ever taken it for sleep, you know you don’t wake up feeling great.All of this means that Benadryl acts on the brain.Which is clearly what it did to JC because as doctors transfer her into the intensive care unit, she suffers her fourth seizure.
|rb-text24=
-那么，这些苯海拉明会到哪里去呢?
如果你曾服用过苯海拉明，你就会知道它能让你昏昏欲睡。这就是为什么它也被常常用于助眠。有些家长会在飞机起飞前给孩子服用，这样熊孩子们就只能在飞机上乖乖睡觉，而不是大吵大闹。'''但是，你不应该这样对你的孩子！！！'''
|rb-text25=
但是如果你曾经为了入眠而服用过它，你就会知道，当你醒来时，你其实并不会感到很舒服。这一切事情都意味着，苯海拉明会对大脑起作用。JC显然就是这样，因为当医生把她转到重症监护室时，她的第四次癫痫发作了。
|lb-text26=
Nurses had to give medicine to stop the seizure, because it wouldn’t stop on its own.The Benadryl deposits not just in her brain, but in all her organs because she took so much of it.This brings us to an idea called '''Lipophilicty'''.'''Lipo-''' meaning fat and '''Philic''' meaning affinity for.
|lb-text27=
Benadryl is lipophilic, meaning it dissolves in fat.We know that water doesn’t mix well with oil, which is a fat.Outside of the cells in the human body, there’s a bilipid layer, meaning your cells are coated and defined by a layer of fat.This would mean that a lot of Benadryl doesn’t want to be in the blood, because blood is mostly made of water— it would want to be in the cells, so it can interact with that bilipid layer.And, more than 60% of the brain is made of fat, which is how Benadryl would get in.
|rb-text26=
护士们不得不给药来阻止JC的癫痫发作，因为它无法自己停止。因为她摄取了太多苯海拉明，所以不仅在她的大脑中，还在在她的所有器官中，都聚集着大量的苯海拉明。这给我们带来了一个叫做“'''亲脂性'''”的概念。“'''Lipo-'''”的意思是脂肪，“'''Philic'''”的意思是亲和力。
|rb-text27=
苯海拉明是亲脂性的，也就是说，它可以溶解在脂肪中。我们都知道，水和油并不互溶，因为油是一种脂肪。在人体细胞的外层是一层脂质层，这意味着你的细胞被一层脂肪包裹着。这意味着大量的苯海拉明不容易存在于血液中，因为血液主要是由水构成的——它更容易存在于细胞中，这样它就可以与胆脂层相互作用。而且，大脑是的组成成分中，超过60%是脂肪，这就是为什么苯海拉明会在大脑中大量聚集。
|lb-text28=
Do you remember those histamine receptors? Well they’re not just in the lungs and the skin to cause an allergic reaction.They’re also in the brain.And while histamine can cause blood vessels to dilate and become leaky elsewhere in the body, in the brain it does different things.It regulates sleep and wakefulness, so if Benadryl is there, cells don’t respond to histamine anymore, so there’s no more regulation, and no more wakefulness.That’s how it causes drowsiness.
Histamine’s also involved in cognition.So if Benadryl is there to block it, then there’s less cognition.Less cognition could mean more hallucinations, which sounds a lot like JC’s case.Histamine also has anticonvulsant activity, so if Benadryl is there to inactivate it, then there would be convulsant activity, explaining her seizures.
|lb-text29=
But she doesn’t just have a little bit of Benadryl in her body, she has 2 whole bottles of it.But if it’s sitting in her organs, blocking all the histamine receptors, and there’s still a lot of it floating around, what else would it block?
|lb-text30=
This brings us back to “'''anticholinergic poisoning'''”.
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你还记得那些组胺受体吗?它们不只是在肺和皮肤中引起过敏反应。它们同样也存在于大脑中。虽然组胺能导致身体其他部位的血管扩张和渗漏，但它在大脑中却有着不同的作用。它会调节你的睡意和清醒状态。如果大脑中聚集有苯海拉明，脑细胞就不会再对组胺做出反应，所以就不能调节睡眠状态状态，也难以再清醒。这就是它引起睡意的原因。组胺也与认知有关。如果苯海拉明阻止了组胺的作用，那么认知就会减弱。更弱的认知就意味着更强的幻觉，正如JC的案例一样。组胺同样也有抗惊厥活性，如果有苯海拉明来灭活组胺，那么抗惊厥活性就失效了，这就解释了她癫痫发作的原因。
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但她体内并不是只有一点点苯海拉明，而是整整两瓶。但如果苯海拉明在她的器官中，已经阻断了所有的组胺受体，而且还有大量的组胺在各处游离，那么，它还会破坏什么?
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这让我们回到“'''抗胆碱能中毒'''”这个概念上来。
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A “cholinergic” refers to the naturally occurring chemical called choline.Which happens to have a similar structure to Benadryl.One part of your nervous system signals for “rest and digest”.This is mediated by the chemical acetylcholine, which is made inside your body.And cholinergic receptors, take in acetylcholine to promote “rest and digest.”But interestingly enough, since we have sequenced the entire human genome, we know what the DNA in our body makes.Nature likes to conserve things, and our genome tells us that almost half of this cholinergic receptor, is just like the histamine receptor.And because Benadryl isn’t too different in structure from choline, then it means having a massive amount of Benadryl in the body, would cause it to bind to cholinergic receptors too.A lot of Benadryl means a lot of these cholinergic receptors don’t get acetylcholine anymore, they get Benadryl instead, meaning, JC’s body can’t signal “rest and digest” either.
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“胆碱能”指的是一种被称为胆碱的天然化学物质。它和苯海拉明的结构很相似。你的部分神经系统会发出“休息和消化”的信号。这是由你体内产生的化学物质乙酰胆碱所介导的。胆碱能受体，通过与乙酰胆碱结合，从而身体促进“休息和消化”。“但有趣的是，既然我们已经完成了整个人类基因组的排序，那我们就知道我们体内的DNA会产生什么。”大自然总是喜欢有所保留，我们的基因组告诉我们，几乎一半的胆碱能受体，就像组胺受体一样（容易被苯海拉明灭活）。因为苯海拉明在化学结构上与胆碱没有太大区别，这也意味着体内有过量的苯海拉明会与胆碱能受体结合。大量的苯海拉明灭活了胆碱能受体，意味着很多胆碱能受体无法得到正确的信号分子——乙酰胆碱，而是得到苯海拉明，也意味着JC的身体也不能发出"休息和消化"的信号。
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Without a digest signal, her mouth becomes dry so no more saliva.Her stomach muscles don’t move anymore.She becomes flushed, but can’t sweat.She can’t and hasn’t urinated since she took the whole bottle of Benadryl.Her pupils become dilated.And her heart doesn’t slow down, it speeds up to the point where it shakes in place and doesn’t actually produce a real contraction.
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In the intensive care unit, doctors give medicines to try and stabilize her heart rhythm.Benadryl doesnt just stop the histamine signal, it doesn’t JUST stop the rest and digest signal.It also blocks sodium going in to heart muscle cells because the other part of its shape happens to fit in those receptors in the heart too.And because JC took a huge amount of it, there’s enough extra floating around to block anything where it can fit.
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因为没有消化信号，所以就不再分泌唾液，她的嘴就会变干。她的腹部肌群也不再运动了。她的脸颊泛红，但没有出汗。而且自从她喝下了整瓶的苯海拉明后，她不能，也无法正常排尿。她的瞳孔放大。但她的心脏并没有减速，而只是加速颤抖，并没有产生真正的收缩。
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在重症监护室，医生通过给药来试图稳定她的心律。因为苯海拉明不只是阻断组胺信号，也不只是阻断休息和消化信号。它还阻断钠进入心肌细胞，因为它的另一部分碰巧也适合心脏中的受体形状相吻合。正因为JC摄入了过量的苯海拉明，所以也有足够多的额外游离的苯海拉明来阻断任何的东西，从而使她心律失常。
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Is there any way we could happen to pull it out of her organs?
Well, maybe. But in most cases, this is treated by... waiting it out.
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Give medicines to stabilize her heart.
Give medicines to stop her seizures if they happen.
Ventilate her so that a machine breathes for her because she can’t do it on her own.
But maybe, there is a way we can exploit the chemical property of Benadryl to treat her.
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Bringing us back to lipophilicity.If Benadryl dissolves in fat, but not water, could we somehow infuse fat into her veins in the hopes that it would pull out Benadryl from her organs?
At this thought, doctors infused the lipid emulsion used to feed critically ill patients, intravenously.JC’s heart rhythm didn’t change after the first infusion. It’s still unstable.Twenty minutes later, doctors infuse another bolus in, and then, her heart stabilizes, and throughout the duration of her stay in the hospital, she never has another abnormal heart rhythm.
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In several case reports of this intravenous lipid emulsion therapy for various toxicities,a positive inotropy was observed, meaning after infusion of fat emulsion, the heart beats harder and stronger.It’s possible that it could be the heart muscle changing energy source from glucose to fatty acid from the emulsion.
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But it could also be additional volume in the blood stretching the heart and causing a rebound reflex.Or it could just be because the toxicity has been reversed.That’s the good part. Sometimes, that bolus of fat can cause pancreatitis, cause the pancreas is supposed to help break down fats, and it can also cause acute respiratory distress, that would be the bad part.
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But in this case, JC turned out OK.And on day 3 of hospitalization, she pulled out the tube that was down her throat.Confused as to where she was, her dad explained to her everything that happened, as she realized that the TikTok fame wasn’t worth the memes, especially since she felt a mental fog and haze from the event, for several months afterwards.
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有没有办法能把这些苯海拉明从她的器官里排出来呢?
嗯,也许吧。但在大多数情况下，便是……等待它自己排出来。
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给她注射用来稳定心率的药物。如果癫痫发作，则给她注射抗癫痫药物。因为她不能自主呼吸，所以给她通气管，并让呼吸机机器替她的自主呼吸。但也许，我们可以利用苯海拉明的化学性质来治疗她。
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回到亲油性上来。如果苯海拉明更容易溶解在脂肪里，而不是水里，我们能不能用某种方法把脂肪注入她的静脉，来尝试把苯海拉明从她的器官里排出来？有了这个想法后，医生们将用于喂养危重病人的脂质乳剂静脉注射进去。JC的心率在第一次注射后没有变化。它仍然是不稳定的。20分钟后，医生又给她注射了一剂，终于，她的心脏稳定了下来，在她住院期间，她的心律再也没有出现过异常。
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在一些病例报告中，血脂乳状液治疗多种毒副反应均呈正性肌力，即脂肪乳状液注射后心脏跳动更强。有可能是心肌细胞将能量来源从葡萄糖转变为乳剂中的脂肪酸。
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但这种方法会增加血液中额外的容量，扩展心脏，引起心血管的减压反射。往好的方向来说，它可能会让毒性已经逆转。往糟糕的方向来说，有时候，那一团脂肪会引发胰腺炎，因为胰腺应该帮助身体分解这些大量的脂肪，同时它也会引起急性呼吸窘迫。
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尽管如此，JC的最终结果是好的。在住院治疗的第三天，她拔掉了喉管。父亲向不知道自己身在何处的她解释了发生的一切，她意识到TikTok的名气并不不值得，尤其是在这件事之后的几个月，她一直感到精神恍惚。
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Viral following is almost never worth it.Because fast up is fast down.Brightest stars burn out the fastest.
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Thanks so much for watching, take care of yourself, and be well.
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博取病毒式的跟风关注从来都是不值得尝试的。恰似海上的浪潮一样，腾涌而起后必定会狠狠地摔落。要知道，最闪耀的恒星也衰竭得最迅速。
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非常感谢您的观看，照顾好自己，并祝你身体健康。
}}
== 笔记 ==
'''Benadryl''',系统命名法:2-(diphenylmethoxy)-N,N-dimethylethanamine
<img src="https://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Diphenhydramine_2D_skeletal.svg/440px-Diphenhydramine_2D_skeletal.svg.png" style="height:90px;" />
国内通常翻译为'''苯那君'''、'''苯海拉明'''。
苯海拉明是一种抗组胺药，是'''第一代的H1拮抗剂'''，会阻断一些组织胺的作用，所以可以用来治疗过敏性皮肤黏膜疾病。
也可以用于治疗失眠、感冒症状、帕金森氏症震颤和恶心（但是作用机制不清楚）。
苯海拉明常见的副作用包括嗜睡、方向感不佳以及反胃，不建议给婴儿服用。目前还不清楚在怀孕时使用的风险，不过不建议在哺乳时服用此药物。