Hi everyone, Dr Bernard here.
This is medicine.
It’s for muscle aches and pains, and you apply it to the skin.
There’s a label on the box that’s required by law here in the United States, and it tells
you how to take it.
It says apply to affected area.
If the area’s not affected, might not wanna apply it there, just like this patient will
find out.
I make a new video every month, so if you hit subscribe and the bell to get notifications,
we can read all the references to subject matter and related cases linked in the description
below, together.
A boy rubbed an entire tube of pain relief cream on all the parts in-between his legs.
This is what happened to his brain.
CG is a 16 year old boy, presenting to the emergency room with abdominal pain, headache
and polyuria.
Poly meaning many and uria referring to urine.
He was urinating excessively.
Earlier the day before, CG was with his friends.
They liked to make fun of where they lived, it’s a boring place, nothing ever happens.
But this time, they were going to make something happen.
One of the friends, Jake, had recently strained his neck when he slept funny one night.
Looking for some kind of therapy, Jake found pain relief cream.
He heard it had some medicine in it.
But it’s also minty, you’ll feel a burn, you’ll focus on that burn and you wont feel
the pain anymore.
Jake, applied some of this cream on his neck and then right after, he had to use the bathroom.
The hand that applied the cream, made contact with all the parts in between his legs.
Immediately after putting his pants back on, Jake could feel his groin go from ice cold
to burning hot as he spent the next 30 minutes in world of hurt to the point where he felt
nauseous.
“If there’s a way to get someone to rub a whole tube of this cream in between their
legs, it’ll be the funniest thing I’ll ever see,” he thought.
One day, while everyone was hanging out, Jake ate a piece of 3 week old pizza, and that
pizza came right back up.
As the friends laughed in his face, he felt embarrassed but then seized the opportunity.
He challenged them— eat a piece of the pizza or rub a tube of this pain relief cream in-between
your legs.
One or the other, otherwise you’re not leaving my house.
Clearly this was a nonsense game played by a group of bored teenagers, but they were
determined.
One of the friends, ate the pizza while the others watched, and that pizza came right
back up.
Pain relief cream is just minty lotion, the other friends said, they use it in hospitals
all the time so it’s safe for everyone, as CG opened the tube.
Immediately after slathering a handful of the cream on all the parts in-between his
legs, CG wasn’t sure what he was feeling.
It felt cold, not really that uncomfortable at first, but then the burn started to settle
in.
As the minutes passed, he felt like someone had put a blow torch to his groin and started
searing it like a steak.
As the pain intensified, he started to panic.
The friends said that even more cream will help neutralize it because if there’s too
much cream in the area, none of it can absorb into the skin so this is totally like an antidote
to itself.
But then the hurt got worse as he rubbed the rest of the tube in.
As CG tried to wash it off, it burned even more.
Everything was red and irritated, he felt like there was a chemical burn on his groin
feeding in to his rear.
As the hour continued, the pain started to fade.
At first, it seemed like everything was over.
But then CG started to feel like the air coming out of his nose was hotter than normal.
He laid down on the floor, and everyone noticed that he was gasping for air.
He didnt realize he was breathing this way because when someone asked, he had no idea
he was doing it.
As the hours pass, a high pitched ringing started playing in his ears that wouldn’t
go away, and the music the friends were playing in the house started shifting in pitch.
His chest was pounding, his arms and legs felt weak.
He would urinate every couple minutes like he had chugged gallons of water, but he didnt drink anything.
When he went into the bathroom to empty his stomach, the friends thought something was
wrong.
CG didnt eat the pizza.
But as they find him laying down in a crooked and twisted position on the floor, they call
for 911, and he’s brought to the emergency room, where we are now.
Bengay Ultra Strength is a mixture of camphor and menthol, both of which are responsible
for the cool, then warm sensation when applied topically, but this formulation also has 30%
methyl salicylate.
This is related to aspirin, known as acetylsalicylic acid, which in the body, they both become
the same salicylate.
This anti-inflammatory is the reason why it’s in the cream, for pain.
These derivatives are some of the most common over the counter medicines.
Pepto Bismol for stomach ailments is bismuth subsalicylate and even some face washes have
salicylic acid.
And it’s the salicylate causing all of CG’s problems, but the medical team dont know that.
Hes too embarrassed to tell anyone what he did.
This probably will pass on its own, he thought, so he just tells the doctors that he hasn’t
been feeling well.
At examination, doctors noticed CG was responsive, so nothing was wrong with his brain.
At least not yet.
His breathing and his heart rate were fast, but his lungs were clear.
His fast breathing wasn’t because something was blocking his airway, and his heart doesnt
have any problems.
A blood test finds he has hyperglycemia.
Hyper meaning high.
Glyce from Ancient Greek Glykys referring to glucose or sugar.
And -emia meaning presence in blood.
High sugar presence in blood.
It wasn’t just a kind-of elevated blood sugar level, it was so high that doctors presume
CG has new onset type 1 diabetes, the type that’s caused by pancreatic damage, not
insulin resistance that can develop later in life.
They presume he’s experiencing an acute illness because of it called diabetic ketoacidosis,
known as DKA.
Keto referring to ketone, a chemical that’s formed in the blood due to the fact that the
body has metabolic derangements.
Acidosis referring to a disorder in the body resulting in a flood of acid floating around
in the blood.
And diabetic meaning that all of this is coming from a problem of how the body handles and
responds to sugar or glucose, bringing us back to hyperglycemia.
Because CG is 16, he’s considered a pediatric patient.
Hypoglycemia this severe doesn’t happen suddenly, it takes hours to days meaning the
body has had some time to adapt in the setting of DKA.
If everything is corrected aggressively and too quickly, overcoming those adaptations
suddenly, could do more harm than good.
But, this is a problem because while DKA needs to be treated slowly in a patient of this
age, CG doesnt have DKA.
It looks like he does at admission, but he doesn’t.
Salicylate poisoning, which is what he has, needs to be treated quickly.
Precious time can be wasted if the medical team doesnt find this in time, as they start
him on insulin that slowly infuses in to him.
Insulin’s a hormone that’s naturally released in your body after a meal, it gets the body’s
cells to absorb the sugar and nutrients from the blood.
It works because his blood sugar becomes normal again over the next few hours.
But the time has been lost now because CG starts to become confused.
He doesn’t look well.
The salicylate poisoning from that tube of cream rubbed in-between his legs is getting
worse.
Another blood test finds he has low bicarbonate presence in blood.
But what does this mean?
Bicarb is a base.
It’s one part of baking soda known as sodium biCARBONATE.
When we breathe air in, our body wants the oxygen from that air, so it can produce energy
and function.
When we breathe air out, our body puts out CARBON dioxide.
Same CARBON as biCARBONATE.
The body wants balance.
If he has low base presence in blood, and the opposite of base is acid, then he should
have a lot of acid in his blood.
Except, that same blood test finds CG’s blood is a little more basic than normal.
This tells the medical team that something other than ketoacidosis is happening to CG
and they need to figure it out quickly.
Skin is not the same across your body.
The skin on your palms and on the dorsum, or backside of your hand are very different.
You can feel it.
You can see it.
Scrotal skin is not at all like the skin on your hands and arms.
It’s thin.
There’s an abundant blood supply going right to this external sac of skin and muscle.
Applying a cream that’s meant to absorb into the area where you apply it, will likely
absorb a lot when applied to somewhere thin, with an abundance of blood vessels, like the
scrotum, meaning methyl salicylate applied here can absorb right in to the blood stream.
There’s structures adjacent to the scrotum, that will likely absorb the cream as well.
In a small science experiment, the scrotum was found to absorb creams rubbed on it at
a rate 42 times more than when those same creams were applied on the forearm.
If CG rubbed an entire tube in between his legs, and that tube is 30% methyl salicylate,
it means up to 55 big tablets worth of aspirin absorbed in to his body.
Just 6 big tablets can start to cause problems in adults.
When you take medicine by mouth, it goes into your gut and then absorbs into your liver
where a large percentage of it is immediately broken down.
This is called first pass metabolism, and explains why medicine taken by mouth sometimes
will have higher doses than their intravenous formulation, because IV goes directly into
the blood circumventing that first pass.
CG, rubbing Bengay on his scrotum, means the methyl salicylate absorbed directly into his
blood, a large portion of it not getting broken down by the liver first so the dose is even
higher than if it were taken by mouth, as it starts flowing around his body.
This explains all of his problems.
Salicylate is a toxin of the mitochondria, powerhouse of the cell.
By disturbing energy production, fats, which are used to produce that energy, are disturbed
in this case, allowing for glucose, which is also used to make energy, to spill into
his blood in huge amounts, to the point where doctors suspected he was having a diabetic
attack, but he just didnt have diabetes.
As the energy production is disturbed more and more by the huge amount of salicylate
in his body now, the mitochondria keep working harder and faster, but nothing gets produced.
If nothing is done about this, more and more salicylate absorbs in to the organs, and there’s
no way to pull it out once it’s in.
It causes the lungs and the brain to swell with fluid.
Because salicylate absorption isn’t reversible, the brain will expand and crush up against
the sides of the skull causing permanent damage.
The fact that hes becoming confused now means that his brain is starting to be affected.
Heat and acid start spilling into his blood, causing acidosis.
His body, tries to compensate for this by breathing quicker.
Carbon dioxide, when it’s in the blood, increases acid content.
Because we breathe out carbon dioxide, breathing faster and harder will suppress acid levels
in the body explaining why his blood was basic while he had low base presence in blood, but
only for a certain amount of time.
The medical team, recognizing this blood abnormality, order some more tests, and they confirm he
has high salicylate presence in blood.
When they asked him if he had some contact with some kind of medicine, he was embarrassed
and he didn’t want to say.
He was partially responsive so he may not have been able to say, even if he wanted to.
But one of his friends blurted out that CG did in fact, rub a whole tube of Bengay on
the parts between his legs.
Young men are well known to rub things like Bengay and Tiger Balm and Icyhot on their scrotum, either
as a joke or as a challenge, or just however young men tend to operate.
There’s more recent reports of men applying it to the region for other purposes.
A general rule of thumb, is to not apply anything to your scrotum if you dont need to.
Especially if it contains medicine.
Water and soap when you need to wash the area, is fine.
Whether or not this particular pain relief cream will make you infertile if you’ve
done this before, i suspect that’s not likely.
There’s people documented to have passed from doing this.
In one prominent case, it was a girl, high school athlete, who applied copious amounts
to a large surface area.
From what I understand, she did not apply it to the equivalent structure in-between
her legs, vaginal mucosa is highly vascularized and is a direct in to the blood stream too,
but she applied an amount enough, often enough, to get high salicylate presence in blood,
significant enough to cause the end of her life.
If you are a man or have biological mens parts, deliberately applying copious amounts of this
cream to this area, you are putting yourself at risk of a poisoning that can become deadly,
because of how much can absorb through the scrotum.
This is the kind of poisoning where you can go to sleep because you’ll be fine for a
while, and then suddenly you just won’t wake up.
After days in the hospital, a lesson learned about not rubbing unreasonably copious amounts
of medicine on sensitive parts of the body, and care from a medical team that was diligent,
CG was able to make a full recovery.
This video is comprised of parts from 2 different cases, done this way to teach about salicylate
toxicity, mixed acid base disorders, diabetic ketoacidosis, and dermal absorption of creams
and ointments.
There appears there could be a rising incidence of salicylate toxicity from this route of
administration for reasons I described earlier.
Thanks so much for watching.
Take care of yourself.
And be well.