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A Man Drank 3 Liters of Rum Everyday Since Age 13
A Man Drank 3 Liters of Rum Everyday Since Age 13
JB is a 27 year old man presenting to the emergency room with "hematemesis": the vomiting of
blood.
JB quickly falls unconscious just before admission. His younger sister Kristin, in tears, tells the
admitting nurse that JB had vomited
three times in the past 30 minutes. You see, JB was playing in a band, Mother McCree's
Uptown Jug Champions. He was notorious to bandmates and fans for downing a fifth of rum
before each concert which averaged five times a week. He needed to do this. His bandmates couldn't
stand him doing this.
This whole thing started from his teenage years. As a 13 year old JB's irresponsible father introduced
him to wine.
As JB detested its taste, he enjoyed the feeling that it gave him. The numbness of the
cheeks and tongue, the slightly darkened vision on the sides of his eyes,
the confidence and euphoria he would feel after finishing what was that first half a bottle of wine.
But then it became a whole bottle that he had to steal from his dad every day. Then he moved on to
rum and did
every day. At age 16, JB's father abandoned the family and three weeks later upon arriving home
from school,
he found a note left by his mother telling him that she's leaving for England to live with her new
boyfriend.
JB dropped out of high school and his only solace was taking care of his little sister, playing in a band
handle or 35 shots of rum first thing in the morning for breakfast every day.
He is also known to drink wine during each concert straight out of the bottle sometimes being so
drunk
he'd sing the wrong song. The band was trying to stage an intervention, but while on tour there was
very little
that they could do. At the hospital with Kristin the band mates tell the admitting nurse that two
weeks ago
they noticed a big change in JB's physical appearance and mental acuity.
His belly had become uncomfortably swollen even though his neck and face had gotten considerably
thinner. His skin and eyes had become a brownish yellow color. At times when they thought he was
supposed to be sober
he was found stumbling over his feet, slurring his words, and presented with an overall confusion.
Earlier in the year
he fell down the stairs and got a bruise that never seemed to go away. As the nurse takes JB's blood
pressure
The volume loss is simple: he's vomited more than 20% of his total body fluid.
JB is hyperventilating, breathing fast because he doesn't have enough blood to deliver oxygen to his
body
and his brain stem detects the sudden drop in oxygen content, it thinks he's suffocating and demands
that he breathes quicker.
His heart rate is high because his heart is trying to compensate for the low blood pressure.
Few of his organs are receiving blood now which means no delivery of oxygen.
JB's body will begin to shut down and go into multi-organ failure.
He has just minutes to live. So you may think: just replace the blood and he should be okay, right?
Well, not by itself and here's why. Both the mass alcohol abuse
described by Kristin and the hematemesis are dead giveaways. JB Is in hypovolemic shock but only
because of
Alcohol, or more formally ethanol is broken down twice in your body, first in your liver by an enzyme
called
"Alcohol dehydrogenase." it breaks alcohol into acetaldehyde, Which is similar to the fluid used to
embalm mummies.
Acetaldehyde make some people red when they drink and it's partly the cause of hangovers
It's poisonous. It damages the DNA in the liver cells. In small amounts of alcohol consumption which
is okay,
but in large amounts it wrongly signals to the liver cells to produce fat. It allows the immune cells to
attack the liver.
When the cells heal they're covered with collagen. It's similar to having a scar on your skin after a
deep wound.
Now everything that JB is suffering from is a result of both liver failure and scarring.
That word derives from the Greek Word "kirrhos" meaning brownish yellow color.
By saying "decompensated" we mean that JB's body can no longer adapt itself to the liver damage
that has occurred.
Why is poop brown? It's the same reason why JB's eyes and skin are brownish yellow. Your red blood
cells,
they're destroyed in your spleen and the remnants are sent to your liver to be broken down even
more.
After the breakdown you get "bilirubin," the chemical that makes your poop brown. The problem
with cirrhosis is that bilirubin is no longer processed.
so nothing is being processed by it. The broken down bits of your red blood cells flow freely in your
blood and
bind to your skin and eyes and make them a brownish yellow color.
Instead of brown poop, JB has brownish yellow skin and eyes. Why is JB confused, slurring his words,
and stumbling over his feet?
and there's a lot of it flowing around in his blood in his case. Your liver helps digest the proteins that
you eat.
Protein contains a lot of nitrogen the most simple form of nitrogen dealt by your liver is ammonia
whereas water contained the central oxygen,
ammonia contains a central nitrogen. That ammonia is typically processed in the liver to become
something that we call more
But since JB's liver is failing the ammonia flows in his blood crosses into the brain and disrupts his
brain cells.
His brain cannot function because the chemicals the liver are supposed to handle are disrupting it.
Finally why is JB vomiting blood? The last point here is that the liver synthesizes
blood clotting factors. When you get cut they come together to help you stop your bleed. The bruise
that JB got after falling is his
muscles bleeding underneath the skin. They'll keep bleeding for a long time because he doesn't have
the clotting factors to stop it.
absorbed into your intestines, and it's processed in your liver. Oral medicines in tablets and capsules
famously go through something called first pass
metabolism. You take the medicine by mouth, it goes into your stomach, and goes into your liver
where it gets broken down
If you took 220 milligrams there might only be 22 milligrams left after first pass.
injecting the drug. For example, these morphine tablets which are supposed to be taken orally are
always at a higher dose than morphine injection.
flows almost directly into the lower part of your heart. When the liver is cirrhosed, blood flow is
blocked.
circulating against the valves of each vein. As the liver becomes less and less functional and more
and more like scar tissue,
the varices build up more and more pressure until they burst.
What's happening to JB's stomach and esophagus is the veins have burst, and the stomach is now
filling with blood.
It's called variceal hemorrhage and if left untreated, he will bleed to death into his stomach.
The most immediate treatment required here is to stop the bleed and transfuse blood into JB.
Stopping the blood flow would be done with rubber band ligation.
They're sent down the throat through a tube and the bands are tied, to temporarily stop bleeding. A
drug known as
octreotide is infused into JB intravenously to decrease blood flow to the abdominal organs.
Finally, allowing the portal vein to bypass the liver through this shunt to short-circuit blood flow
through the liver
decreases the pressure back up in the stomach. It's a little newer of a technique and a little risky.
It's transjugular meaning that they enter from your neck. Intrahepatic means that it goes through
your liver, and
portosystemic meaning connecting portal vein to systemic vein. In the old days, they would have
used this balloon
tamponade, where balloons were sent down your throat and inflated just at the top of your stomach
but this had a chance for you to breathe in the contents of your stomach or
perforate your esophagus. These are only temporary solutions to keep JB alive until his liver is
replaced, these problems won't go away. Without liver transplantation, JB cannot survive this
medical emergency.
We can temporarily stop the blood flow backing up with bands, medicines, and shunts. We can treat
his
But obtaining a liver for transplant would mean we need to find a matching donor.
349 in 2006.
You need to be on a waiting list to get a transplant. There simply isn't a large quantity of livers
available.
We can't grow livers magically. If someone passes away, their liver may not be suitable for
transplantation
With how difficult it is to obtain a matching donor for a liver, the fate of JB is up to the caregivers for
monitoring him
and waiting for a liver to become available. The outcomes of alcoholic cirrhosis
are not glamorous. No more than 1 to 2 shots per day, without
rollover, of hard liquor or equivalent before age 65, and, no more than one afterwards is the
surgical procedures, genetic engineering and whatever technology that may be available at any point
in time,
alcoholism is a human problem that will always be best solved from the support of other humans.
Luckily for JB,
27 year old body was able to accept the transplant. With social support from his little sister
Kristin, his band and with newfound wisdom of the dangers of mass alcohol consumption,
The only similarities here were Mother McCree's Uptown Jug Champions, the age of 27, and the
cirrhosis.
He was a counterculture icon said to have cursed the keyboard seat of the Grateful Dead as every
other full-time
keyboardist of the band after him died by accident. Pigpen himself died of variceal hemorrhage in
1973 a time when octreotide wasn't available and the transjugular intrahepatic
Thank you so much for watching. Take care of yourself and be well.