A Woman Ate A Suspicious Hamburger For Dinner. This Is What Happened To Her Kidneys.
JC is a 30 year old woman, presenting to the emergency room nauseous.
She tells the admitting nurse that anything she ate or drank, would immediately squeeze
out her other end as a watery stool. But over the last several days what was watery became bloody.
JC was always relaxed when it came to food.
When she was 10, her single dad surprised her with pizza for dinner on their weekend together.
As the night went on, they got tired from playing video games,
and fell asleep on the couch. Dad didn’t know how to cook, so in the morning,
they ate the pizza that was left out on the table for breakfast. Then they had it for lunch,
and then dinner again as it sat out on the table, the entire day.
In dad’s mind, pizza’s salty and you know, it wasn’t that long ago that humans used salt on
their food to preserve it because they didn’t have refrigerators. If salty was good enough for them,
it’s good enough for us, he thought. JC and dad would eat it again for breakfast,
lunch and dinner on Sunday as it had been left out for 36 hours. Dad, told his daughter,
don’t let people scare you. There’s no reason to be overprotective about food.
It all comes out the same end. He’d pack it for her lunch on Monday.
And everything would be great. It was like this every weekend. JC never got sick. As an adult,
she’d leave burgers on her desk while she worked. She’d nibble on them throughout the day,
and when she came back the next, it would still be there for her eat.
Food poisoning isn’t real. I just have my dad’s good genetics, she thought.
One day, JC made a burger for lunch. She had heard recently on the news about a
recent bacteria outbreak on lettuce, similar to the kind she was putting on this burger,
but food poisoning’s a sham, how many people this gonna affect? 10? who cares,
as she nibbled on it while doing work at home. It was getting late. She fell asleep at her desk,
and when she suddenly woke up at 3am, she felt hungry. The burger was cold, maybe kind of soggy,
but still just as good, she thought, as she finished the entire thing, and went to bed.
In the morning when she woke up, her stomach kind of hurt. There was a watery stool that flowed out.
As the day continued, JC would notice her stomach would shake and convulse at random times before,
another watery stool would ooze out. Anytime JC ate or drank anything,
even a single sip of water, she’d get the runs.
Over the next few days, JC kept feeling worse. That burger was kind of suspicious, she thought,
but there’s no way. This doesnt happen. I've done worse before, and nothing happened then,
so nothing’s happening now, she thought. JC tried taking some stomach medicines to
help stop the watery outflow, but nothing would work. She started getting a headache,
she felt she was dehydrated because she had stopped urinating for at least
an entire day. She wasn’t sure if she was hungry anymore because her stomach would keep moving,
and shaking. But finally what was watery became bloody, everywhere in the toilet
as she calls for 911, and she’s brought to the emergency room where we are now.
At examination, doctors notice that JC’s skin was kind of discolored.
She was clutching her stomach in pain. When the medical team asked her for a urine sample,
she told them that she couldn’t remember the last time she urinated.
JC was dehydrated because of all the explosive watery stools exiting her body.
But a blood test finds that wastes that are supposed to be filtered by her kidneys were
floating around in her blood at levels several times the upper limit of normal.
If she hasn’t made any urine for at least a day and these wastes are floating around
everywhere, then it means her kidneys have completely shut down, but why is this happening?
Well, there’s a little basic human physiology to be known here. In an average human, the kidneys
filter 170 liters of blood daily. That’s 85 2 liter soda bottles. If the average blood (plasma) volume
circulating in an average human is 5 liters, then the kidneys filter all of body’s blood at least
34 times over, everyday, meaning that if JC’s kidneys are shutting down, there could be a
problem blocking flow in to the kidneys. This is something we call prerenal acute kidney injury.
Pre meaning before and renal referring to kidney. This could make sense because she’s dehydrated,
that would cause a low volume of blood and fluid going to her kidneys, but it seems like a lot
more is happening because hours after JC is rehydrated, she still isn’t making any urine.
The medical team orders more blood tests and finds that JC has anemia. An meaning without and emia
meaning presence of blood. For some reason, there’s less red blood cells than there should be,
but why? Nutrient deficiencies can cause less red blood cells to be made, but JC seems to be
OK there. It could be her blood cells are getting broken up and smashed to pieces for some reason,
but if that’s happening, then contents of those red blood cells should be floating around, and the
blood test finds, the contents of those red blood cells are floating around. Looking at her blood
under a microscope finds fragments of shattered blood cells, meaning that JC has hemolytic
anemia. Hemo meaning blood and lytic from lysis meaning a breaking down of. An absence of blood
because blood cells are getting destroyed and smashed, bringing us back to JC’s kidney injury.
Inside the kidney is a network of vessels that are specialized for handling all the wastes in
the blood, so those wastes can be put in the urine and removed from the body. If her kidney injury
isn’t because of something pre renal because she was rehydrated and still didnt make any urine, afterwards,
then it means something could be failing inside her kidneys, but what could it be?
When she presented to the emergency room, the medical team collected a stool sample,
so they could grow the bacteria in it. The watery stools becoming bloody hinted what could be
happening. Days later, what appeared in the culture, revealed everything happening to JC.
Escherichia coli, E coli, is a common bacteria found in times when someone has an accident from
food. Typically, E coli causes an illness that’s self-limiting, meaning it can cause abdominal
cramps, nausea, vomiting, diarrhea, but after a couple days up to a week, it goes away. E coli
doesnt usually cause the kidneys to completely shut down, but because JC’s stool culture grew E
coli, it’s there, it’s causing her illness, and it means she doesnt have a usual strain of it,
but a special one called E coli O157:H7, also known as Shiga toxin-producing E coli.
As the bacteria is consumed by mouth, it goes into the gut,
like how everything does. Bacteria is normal and everywhere in the gut, so that’s not going
to be a problem. This particular E coli sticks to the surface of the intestines and then starts
secreting it’s toxin, releasing it everywhere into the lumen, or the hole, of the intestines.
Shiga toxin is naturally occurring. It’s a protein. It happens to be in the same
family of proteins as ricin, another toxin naturally occurring in some beans
that’s become notorious in the news, used nefariously in high profile cases.
Inside the intestines, Shiga toxin binds to the surface of the cells, where it’s let inside.
As it floats around, it locks the cell and stops normal activity. Structures and proteins the cells
need to use and produce can no longer be made, as the cells start to die.
As the days pass, the E coli bacteria lets out more and more toxin, destroying the inner lining
of the intestines. The immune system comes in because it detects that an injury has occurred,
all of this causing JC’s bloody stools. But it’s not done here.
The toxin absorbs into the blood stream and starts circulating the body. We’ve
already established that the kidneys filter the blood multiple times over throughout a day. So,
as the toxin lodges into the blood vessels of the kidneys,
the cells in the inner lining let the toxin in. Proteins and structures can’t be made
as the cells start to die. The immune system detects this injury too, but the lumen of a kidney blood vessel
is smaller than the intestines, and little blood clots lodge in, trying to protect the
kidney and respond to the vascular insult, but instead, blood flow inside the kidney is blocked,
shutting it down. And as blood tries to flow through, the red cells crush up and smash against
the clots causing hemolytic anemia, but where did this Shiga Toxin producing E Coli come from?
At this finding, the medical team contacted the state health authority.
E coli O157 is the bacteria that was found on contaminated romaine lettuce. As communication
between the hospital and the local Center for Disease control was established, a history on
JC revealed that the romaine lettuce she put and ate on her burger was from an affected lot,
and the lettuce was produced in the region implicated in this bacterial outbreak.
E coli outbreaks happen, and illness in the worst cases can end in tragedy. Almost every year,
the CDC in the United States has reports a new outbreak. The bacteria, is known to live inside the guts of
cows and goats, and in certain places, it’s not implausible that what becomes steaks and burgers
comes into direct or indirect content with the bacteria on the slaughterhouse floor (strong precautions are taken so that doesn't happen), or somehow
water comes into contact and then is used to wash over vegetables, like romaine lettuce,
or however that process works. No food is ever going to be 100% clean. Setting up a robust system
among all the people who will handle any kind of food that will be eaten, is best, but this was
a freak accident. In cases where you’re cooking food, if it’s burgers, more than 160 Fahrenheit,
get a thermometer. If it’s steak, you’ll want 145 Fahrenheit for at least 3 minutes. These are when
you’re cooking for yourself. Don’t brush off these kinds of warnings when they come out, I know the
chances of it happening specifically to you might be low depending, but it’s going to happen to
someone. That’s about the most any one person can do. At restaurants when E coli outbreaks happen,
it hits their business so hard that profits wont recover for several years, if they even recover at all. But in those cases,
tanked sales won’t bring people who were lost from the illness back. And those tanked sales
can’t fully restore someone’s organs that have shut down from the illness, bringing us back to JC.
In the hospital, the medical team knew there is no specific treatment for Shiga toxin producing
E coli. Antibiotics can kill the bacteria, but the body, from the information we have, appears
to take care of it. Given that some antibiotics can be nephrotoxic at a time when there’s an acute
kidney injury made from a toxin from the bacteria, it looks like the benefit does not outweigh the
risk in this particular setting, so no antibiotics were given. The team kept her hydrated and
watched her closely to make sure that her other organs didnt shut down because of Shiga toxin.
As the days pass, JC finally makes urine again. At discharge, her kidneys appeared to function
almost as they did before she ate this suspicious burger, as she was able to make a full recovery.
Thanks so much for watching. Take care of yourself. And be well.