Hey, Dr Bernard here. This is medicine. There’s a label on the bottle, required by law, that tells
you how to take it. Cooking food in it, is not how you take it. You can cause massive, irreversible
damage to your body using it improperly like that, as I’ll tell you about in this video.
Also, the Nyquil chicken meme isn’t new. Someone sent this to me on Twitter, July 12,
2020. If you search, the exact image was making its
rounds on Twitter that particular day. So, the FDA Consumer Update about Social
Media Challenges Involving Medicines, mentioning NyQuil Chicken September 15, 2022, I’m guessing,
was written by an FDA staffer who remembered that particular image, and wrote it in to the
Update sometime in between these 2 years. I don’t believe they went out of their way to report
this specific trend, it was just an example that they cited. Then the media picked up on it,
and the idea was presented as new and amplified by orders of magnitude. This wasn’t an ultra viral
trend before the news stories dropped, so because of that, I don’t know of any specific cases of
NyQuil Chicken poisonings leading to a hospital admission, at the time of recording this. However,
the ingredients in here are used by at least 60 million Americans every week. It’s safe when used
per label, but sometimes mistakes happen, and we do have tens of thousands of cases of those
poisonings involving these medicines every year. So in an effort to make it so there aren’t any
specific cases of nighttime cold and flu medicine chicken going forward, I will tell you about what an
actual poisoning of this looks like, by using the story prompt of someone cooking chicken like this.
A Man Cooked Chicken In Nighttime Cold and Flu
Medicine. This Is How His Liver Shutdown his Brain.
OP is a 19 year old man, presenting to the emergency room, unconscious.
His mother Lana, tells the admitting nurse that her son had suffered at least 2 seizures before
she noticed that his skin and the whites of his eyes were a greenish yellow color.
She had no idea what he had been doing for at least the last 48 hours, because he had
locked himself in his room before she broke in after hearing him shaking all over the floor.
OP was someone who liked memes. Every day, first thing in the morning, he’d reach for his phone to
dump images online. His parents believed that their son had a problem. Sometimes,
they’d see him sitting alone in a room, silent and staring off into space, when suddenly they’d hear
him cackling maniacally because he remembered a random meme he posted online 2 years ago.
He’d spend hours everyday just scrolling, and the funnier he found a post, the more his face
would express no emotion while he breathed a larger volume of air, out of his nose.
One day, OP came across chicken cooked in night time cold and flu medicine. He saw the
rich turquoise greenish color of the meat outside, and the partially cooked inside. Chicken pink raw,
however taste very good, he thought, as he prepared himself for what he was about to do.
In the kitchen now, OP whipped out some chicken breasts into a pan,
and he poured at least 2 bottles of night time cold and flu medicine. He made sure to record
it all so he could meme the video. But as the chicken was starting to cook in the medicine,
he felt the smoke waft up into his nose, and a stinging pain started piercing into his eyes.
It must be ready to eat now, he thought, as he ate the chicken, and drank the remaining juice.
In the minutes after finishing his meal, OP thought he felt his vision starting to slow
down. He could hear a bell ringing in his ears, like he was sitting at a funeral. Time to play
some cringe video games, he thought, as he stumbled over to his computer.
As the hours passed, OP kept thinking that he was seeing lights flashing and hearing sounds
that may not have actually been there. He thought his dad walked in on him,
opening the door and slurring out the words, “are ya winning son?,”
as the door slammed shut. OP wasn’t sure if he dreamed that, because the next thing
he could remember was waking up on the floor with a mouth as dry as the desert,
only getting up because he had to scramble to the bathroom and empty his stomach into the toilet.
As the day continued, OP kept feeling worse. Every time he emptied his stomach,
he noticed the contents in the toilet were a greenish yellow color, the same color as his
skin and the whites of his eyes. He wasn’t sure if he couldn’t think correctly anymore because
he was wondering if what was being pushed into the toilet from his stomach was actually parts
of his skin sloughing off and melting into the ground. His breathing starts to become
labored, and as his stomach starts to hurt more and more, he can feel his head start pounding.
He can feel his eyes push out of his skull, as he lays down on the floor in a fetal position.
As at least 36 hours pass, OP starts to convulse. In the other room, Lana had no idea where her son
was or what he was doing, but as she walks in and finds him shaking on the floor,
she calls for 911 and he’s brought to the emergency room where we are now.
At examination, doctors immediately see several clues telling them what’s happening. First, OP is
jaundiced. This yellowing of his skin and eyes is from a chemical called bilirubin, something
produced from breaking down red blood cells in the liver. If there’s so much bilirubin floating
around in the body that it’s attaching to his skin and his eyes, then it means that something
must be wrong with his liver, and a blood test finds confirms this because parts of his liver
have died, and are leaking their contents around in his blood. But this isn’t his only problem.
The same blood test reports that his kidneys have also shut down, all of this giving doctors
clues as to what’s happening, because they don’t know exactly what he put in his body.
Nighttime cold and flu medicine is typically a mix of 3 active ingredients. Dextromethorphan,
which is a cough medicine, doxylamine, which is used as the sleep aid giving the way to the
night time branding of the medicine, and acetaminophen, also known as paracetamol,
which is a pain reliever and an anti-inflammatory medicine meaning it can help with the aches and
fevers associated with flu. These 3 medicines alone, explain everything happening to OP.
As doctors move OP into the Intensive care unit, they stick a tube down his throat so
that a machine can help breathe for him. Clearly if he presented to the emergency room in a coma,
something happened to his brain, but which medicine did that?
Dextromethorphan, can cause hallucinations and psychoactive effects. In very large amounts,
it can cause serotonin syndrome, where too much of a chemical that sends signals in the
brain can cause problems. OP thought he could see and hear things, and he might have been able to,
but the dose he consumed from the bottles of this particular formulation, is much less
than a dedicated cough syrup. It could have been enough to cause some hallucinations,
but it likely wasn’t enough to cause serotonin syndrome because he doesn't
have the signs and symptoms of that, and so, dextromethorphan might not be the culprit.
But how about the ingredient that increases drowsiness, the doxylamine? This is why it's
branded as nighttime medicine. If it makes one sleepy, then it should affect the brain right?
Well, it could. But doxylamine isn’t just a medicine for drowsiness. It’s also an allergy medicine,
it works similar to how Benadryl does, so OP could have had hallucinations from this too. But the
dose of doxylamine in this formulation isn’t very high. It could explain his dry mouth and
his blurred vision, but it shouldn’t cause liver and kidney failure, especially in this severity.
All of this leaves us with the final active ingredient, acetaminophen. At the doses indicated
on any medicine label, acetaminophen is safe. However, acetaminophen happens to be in many
different over the counter medicines, and while people may follow the directions on the label
of one medicine, they could be taking another medicine, following that label too. This means
that the person following these labels correctly, are unknowingly doubling or tripling their daily
acetaminophen intake. Even worse, they might also be taking prescription medicine, like hydrocodone
for pain, and that also contains acetaminophen. The active ingredients tell you most of what you
need to know. The acetaminophen in here, is the same active ingredient here. This means
that following the label exactly on both bottles could still net you an overdose if that person
isn’t paying attention to what they’re putting in their body. Always read the label and check.
OP consumed at least 2 bottles of nighttime cold and flu medicine when he cooked his chicken in it,
and drank all the remaining liquid. And the fact that it was liquid,
makes things even worse for him.
If you take acetaminophen for aches and pains and fever, you’ll likely take it in tablet or capsule
form. In the stomach, it takes time for these to dissolve, before they pass through and absorb into
the blood stream through the small intestines. Liquid medicines don’t need to dissolve,
they’re in a form ready to be absorbed into the blood, meaning that OP’s poisoning was happening
much quicker. When it absorbs into his blood from the gut, the first place it reaches is the liver.
This brings us to an idea called metabolism. The substances that some folks use and abuse,
are often administered through the lungs in the form of smoke,
or it’s put into a nasal or mucous membrane, or it’s injected. If you look at how the blood
vessels are mapped in the body, these routes of administration get the substances to the brain,
before they get to the liver. This is significant, because the liver metabolizes,
or breaks down, everything that enters your body. When you ingest medicine by mouth, half,
if not more of the dose you took, is metabolized in the liver first, inactivating the medicine
in an effort to protect your body from something that’s 1) not made in your body and 2) shouldn’t
be in excess in your body. Smoke and injection bypass reaching the liver first, so that a
higher amount can get to the target organ. All of this explaining everything happening to OP.
As the nighttime cold and flu medicine absorbs into his liver, all the acetaminophen starts
to get processed. The interesting thing about the liver, is that it uses multiple ways to metabolize
any given substance. These different pathways make the liver more robust in the case that should
one pathway be overwhelmed for some reason, a different one can step in to continue the process.
This is what happens to acetaminophen. But in the case of overdose, bad things start to happen.
As more and more acetaminophen floods into OP’s liver, the first non-toxic metabolite
isn’t made as much. The liver moves on to the second pathway, breaking acetaminophen into
a reactive chemical. Because it’s robust, the liver is still fine with this, it has stores of
a chemical named glutathione that can neutralize this reactive chemical. But because OP consumed
so much acetaminophen, more and more reactive metabolite keeps accumulating, and the liver
starts to run out of glutathione, and there’s no more pathways for the liver to handle this.
When chemicals are reactive, they want to become more stable. In the body, you typically don’t want
reactive chemicals floating around, because they’ll try to stabilize themselves by taking
bits and pieces from parts of the body. And in OP’s case, the toxic acetaminophen metabolite is
reacting with his liver. At first, it interferes with the mitochondria, making it harder for cells
to produce energy. But then it starts ripping off parts of cells in an effort to stabilize itself.
As the cells start to die because they’re reacting with the metabolite, the liver starts to lose its
capacity to process the body’s waste, becoming even less capable of handling acetaminophen.
As the days continue, OP’s blood starts showing that these dead parts of his liver are floating
around in his body. Even more acetaminophen metabolite floods his liver, killing even more
cells, as the liver shuts down and waste continues to build up his body. Bacteria and cells in the
gut produce ammonia, which in normal function is processed by the liver. It’s converted to
glutamine. As OP’s liver keeps necrosing from the massive ingestion of acetaminophen, the ammonia
spills into his blood causing hyperammonemia. Hyper meaning high. Ammon referring to ammonia,
a substance produced by the normal breakdown of proteins and -emia meaning presence in blood.
The brain tries to compensate for this presence in blood because brain cells have some ability
to metabolize ammonia to glutamine, just like the liver can. But as the massive amount of
ammonia overwhelms OP’s brain cells, a fluid imbalance starts to happen as the brain starts
to swell. At first, the skull has a little room for the brain to expand, but as the liver quickly
becomes unable to handle anything because it has completely shut down, more and more ammonia spills
in causing the brain to swell even more. All of the survival mechanisms in the brain cells become
overwhelmed suddenly, as the brain starts to crush up against the sides of the skull, smashing blood
vessels and causing the brain to ooze through the sutures of the skull causing permanent damage.
Is there anything that can be done for OP? Well, maybe. Time is the most important
factor. Unmetabolized acetaminophen isn’t toxic, but there isn’t currently a way to
stop the liver from metabolizing it. If the liver can handle the toxic metabolite with
its stores of glutathione, then the solution is to replenish the stores of glutathione.
N-acetylcysteine is the antidote because it does just that, and prevents the toxic
chemical from reacting with liver cells. If permanent damage is extensive in the liver,
then the antidote wont help, because the damage has already been done,
and a liver transplant would be the only remaining solution. Because OP had neurologic
signs and symptoms when he presented to the emergency room, things don’t look good for him.
In the FDA consumer update, it says Boiling a medication can make it much more concentrated.
Boiling wont create a higher dose, it won’t create more of the active ingredient,
but it will take some liquid out. More concerning is the idea of stability. Heating something up
means the molecules move faster. This increased kinetic energy can make everything less stable,
and the chemicals may break apart in order to stabilize,
and you won’t know exactly what you’re getting at that point. Whichever the
case is, don’t cook anything with any prescription or over the counter medicine.
OP was not able to get a liver transplant in time, and he was not able to make a recovery. His case
was from an intentional massive acetaminophen ingestion, no idea what product specifically
it was, because like I said earlier, acetaminophen is included in so many common over the counter and
prescription medicines that 60 million Americans consume it weekly. At doses on the label, and if
you have no prior health conditions, and you’re only just taking this one medicine, our bodies
have enough glutathione to handle the metabolite. It does take a lot of this to cause damage like
in OP’s case, but if you accidentally combine too many medicines like how an elderly person in the
retirement home might, or you think it’s a funny meme to mess around with whole bottles like this,
the damage can be permanent. This is why you don’t want to cook food, in this medicine.
Thanks for watching. Take care of yourself. And Be well.