A Man Drank Suspicious Coconut Water For Lunch. This Is What Happened To His Brain.
AC is a 39 year old man, presenting to the emergency room, unconscious.
Paramedics tell the admitting nurse that they found him in his house sweaty, nauseous, with
pale skin, and laying down in a crooked position.
Earlier that day, AC was living his regular life. He was hungry for some food and when
he looked, he found a Sweet Young Coconut, sitting on his kitchen counter. This coconut
isn’t like the hairy regular ones you find in the produce section at the grocery. It’s
shaved and found in the refrigerated section. It’s the one you buy to get delicious Coconut
water from. The low temperature of the refrigeration helps limit microbial growth, and that’s
important because some bacteria and fungi enjoy and thrive on the natural juices of
this fruit. But, AC wasn’t aware. He remembered that he had been seeing this particular coconut
on his kitchen counter for at least the last month, as he poked the pre-made hole in, and
started drinking.
Immediately as the coconut water touched his tongue, he knew something was wrong. The taste
was so terrible that he spat it out, but not before he swallowed some of it. He noticed
there was a smell coming from inside the fruit. He tried cutting it open, and when he could
finally look inside, he saw it was slimy and rotten, as showed it to his wife, and threw
it away. He kept rinsing out his mouth because the taste lingering in his mouth was so awful,
but he was sure he completely washed it out.
As the hours passed, AC started feeling funny. At first, he noticed he was sweating, but
the room wasn’t really that hot. He felt his palms were kind of damp, maybe a little
clammy. In the bathroom now, AC could feel a tinge in his cheeks, as a sour taste rushed
into his mouth from under his tongue, and he emptied his stomach in to the toilet in a way like never before.
Unsure of what was happening, he looked in the mirror and noticed that his complexion
was pale and gray, but the image that he saw in the mirror was starting to not make sense.
As he stumbles out of the bathroom, he loses his balance. On the floor now in a crooked
position, not knowing where he was, not knowing what was happening, he was able to summon
enough strength to call for 911. In the ambulance, paramedics noticed that AC could still respond
to questions, but it took him some time before he could speak his response. But as he’s
brought to the emergency room, AC becomes unresponsive.
At examination, doctors found that AC’s heart was still beating but his blood pressure
was high. When they shined a light into his eyes, his pupils could still react and constrict.
All of this meaning that at least one part of his brain was still functioning, for now.
A blood test finds that AC has metabolic acidosis. Acid in this context being a waste product
of metabolism, or cellular activity, but more formally known as the concentration of hydrogen
ions in his blood and -osis meaning a disorder of. A disorder of excess acid due to cell
activity, but which cells are doing this?
The medical team notices that AC’s forearms and his calves would randomly jerk. Given
that he was found by paramedics in a twisted and crooked position, there could be something
wrong with his muscles, but the nervous system controls the muscles, so which one has the
problem?
In the intensive care unit, AC’s body temperature is now higher than when he presented
to the emergency room. If 1) he has acid in his blood because of abnormal metabolic activity,
2) he quickly became unconscious in the ambulance, 3) his muscles are twitching randomly, and
4) he now has a fever, then this could mean that AC has an infection that’s somehow
affecting his brain called meningitis. -itis meaning inflammation of the meninges, layers
of membranes surrounding the brain and the metabolic activity causing acidosis might
be from a problem with his cells in reaction to the fact that bacteria is now growing in
his nerves and his brain. But how can the medical team be sure that this is what’s
happening?
Doctors send a needle into his back to collect cerebrospinal fluid to test. If bacteria is
infecting his brain, this fluid should give some clues that something is growing inside.
But time is quickly running out. The medical team doesnt know for sure if he has an infection.
They start him on antibiotics in hopes that if this is an infection, some of the bacteria
can start to be handled immediately.
What doctors also don’t know about, is the suspicious coconut water that AC drank. He
couldnt tell them about it because he was unconscious. His wife told doctors that AC
had showed her a rotten coconut just hours before she found him crooked and sweaty on
the floor. And this gives doctors some clues as to what’s happening because as the labs
return for the cerebrospinal fluid, it looks like there isn't any infection in AC’s brain
at all.
When a fruit becomes rotten, it's anyone's guess as to what kind of bacteria and fungus
were growing and thriving inside. In medical literature, rotten coconuts and corn have
been associated with Bongkrekic Acid, a mitochondrial toxin that’s made by Burkholderia bacteria,
which sometimes appears as a result of incomplete fermentation. This gives us a couple of clues.
First is that a rotten coconut that’s slimy on the inside likely has bacteria and other
microbes growing in it. If AC consumed part of rotten fruit, and that particular fruit
had microbes growing in it, and those microbes can produce mitochondrial toxins, and the
mitochondria is the powerhouse of the cell but can’t be, because a toxin is prevent
it from performing cellular metabolism, resulting in AC’s metabolic acidosis, then all of
this should make sense. Except, when the coconut was tested, the lab couldn’t find any Burkholderia
bacteria. They tried multiple different tests, and even tried to look for bongkrekic acid
itself, but none of it was found.
An MRI of AC’s brain reveals that fluid has been swelling into his brain, particularly
in the parts that control movement, learning, and memory. A blood test finds that he has
hyperammonemia. Hyper meaning high. Ammon referring to ammonia, a chemical made as a
result of the body breaking down proteins, and -emia meaning presence in blood. High
ammonia presence in blood.
Proteins are large compared to simple chemicals. They’re long chains of simple chemicals,
so the body can chop them down, to digest and handle them. Gut bacteria do that digestion.
Each chain link in any protein are called amino acids. Amino, referring to the chemical
group, amine, which contains Nitrogen. Life on earth all require nitrogen. It’s why
you hear needing Nitrogen in the soil with fertilizer, and from an ecosystem perspective,
the exoskeleton on some bugs contains chitin, which is a significant container of nitrogen.
If nitrogen is the essential part of AMINEo acids, which is what proteins are made of,
and the body needs to break down those proteins to get the nitrogen in order the function,
then it makes sense why our bodies normally make Ammonia, because that’s the simplest
nitrogen chemical that can exist, but it also makes sense as to why AC has hyperammonemia.
The liver requires a lot of energy to function. If AC somehow ingested a mitochondrial toxin
from suspicious, rotten, coconut water, it could prevent his liver cells from producing
the energy needed to handle Ammonia flowing in from his gut. AC’s brain, also an organ
needing lots of energy to function, was already impaired because of the toxin, but as extra
ammonia starts floating around in his blood, because his liver has shut down, it gets in
to the brain. It causes fluid to start to swell in, meaning as AC’s brain starts shutting
down, his liver shutting down makes it even worse. But it’s not his only problem. The
same blood test finds that parts of AC’s muscles have broken off and started spilling
in to his blood, likely because his brain had trouble controlling the contraction and
relaxation of his muscles, and because muscle tissue is also energy dependent, this should
make sense. Those muscle remnants collect in his kidneys and rip apart the tubules,
causing his kidneys to shut down too.
The medical team notes, AC doesnt have meningitis. He doesnt appear to have any bacterial infection.
The rotten coconut from where he took a sip of the suspicious water also didn’t have
the Burkholderia bacteria that would make the bongkrekic acid mitochondrial toxin that
could cause all of his problems. But given that his brain is swelling with fluid, his
liver has shut down and allowed ammonia to spill everywhere in his blood, parts of his
muscles have sloughed off and are now floating around in his blood causing his kidneys to
shut down, what else could have been in that coconut?
In the lab, further examination of the coconut finds the presence of the fungus Arthrinium
saccharicola, known to produce the toxin 3-nitro propionic acid. In the mitochondria, this
toxin is shaped like a chemical that’s normally used to help produce ATP for energy. When
the toxin is present, instead of the mitochondria using the normal chemical, the 3-nitropropionic
acid slides in and prevents energy production. As cells of the brain, especially in the areas
that control movement, start to panic and run out of energy, some of those cells start
to die. Muscles cant be controlled properly anymore and they dont have sufficient energy
to function, as they start to float around in the blood. The liver cells also start to
die quickly, and ammonia can’t be handled anymore, causing the brain to swell even more.
All of this happening because AC unfortunately drank suspicious water from a rotten coconut,
that had mold growing in it.
24 hours after AC presented to the emergency room, a scan of his brain showed severe swelling.
Because the brain is enclosed inside a hard space, the skull, there’s only a limited
amount of space for it to swell before it starts to crush up against the sides of the
skull and ooze through the sutures, or the cracks in the skull. And on the scan, it looks
like this brain herniation was impending. AC’s pupils no longer responded to light,
reflexes that would show that his brainstem still conducted and communicated signals in
the body, were no longer in tact. AC could no longer breathe for himself and at 26 hours
after admission, the medical team needed to make a decision with his wife whether to continue
treatment.
When it comes to food, especially fresh produce fruits and vegetables, it’s important to
keep them fresh. If they need to be refrigerated, refrigerate them. Be cautious with expiration
dates, that’s not to say go overboard and throw everything in sight away because you
heard of one video online talking about someone getting catastrophically ill from drinking
suspicious coconut water, but if something smells weird, looks weird, tastes weird, just
be careful. Sometimes, it isn’t even the bacteria or fungus growing on the food that
can cause problems, but the fact that those microbes could produce chemicals that are
toxic to humans, that is what can cause issues. It’s not common, and sometimes accidents
happen, and relatively exotic things, like drinking from a coconut can lead to mistakes,
just like AC’s case.
At autopsy, bleeding was found in AC’s brain. Reexamination of the coconut and a sample
of his blood found the 3 nitro propionic acid mitochondrial toxin that was responsible for
everything that happened to him. This toxin was something made by the Arthrinium saccharicola
fungus that was found in the rotten coconut from which AC had a drink of this suspicious
water.
Thanks so much for watching. Take care of yourself. And be well.