User:りょう ゆそう/A TikToker Drank 2 Bottles Benadryl. This Is What Happened To Her Organs.

• 本视频在2020年9月16日投稿至油管
• 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。

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正文区

Hi, Doctor Bernard here. Don’t do this.

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.

DON’T DO IT!!!

JC is a 21-year-old woman, presenting to the emergency room, unconscious.

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 like a rag doll.

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 internet-famous.

A small trend was growing over the weekend. This is going to be something big, she thought.

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.

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.

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.

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.

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, grinding each other down into sand.

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.

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.

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.

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.

-But what does that mean? -What is a cholinergic? -And what does it have to do with Benadryl?

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 leakier, in the hopes that the allergens will leak out.

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.

-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!

-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.

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.

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 let’s 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.

-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.

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.

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 Lipophilicity. Lipo- meaning fat and Philic meaning affinity for.

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.

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.

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?

This brings us back to “anticholinergic poisoning”.

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.

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.

In the intensive care unit, doctors give medicines to try and stabilize her heart rhythm. Benadryl doesn’t 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.

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.

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.

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.

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.

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.

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.

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。