A Bitcoin Miner Heatstroked In His Sleep.
This Is How His Organs Shutdown
CW is a is a 23 year old man, presenting to the emergency room, unconscious.
His mom, Karen, tells the admitting nurse that she found her son, slumped over in his
bed, unresponsive.
He had been acting funny over the last the few days.
You see, CW had just graduated college 2 months ago.
He got a degree in engineering, but from a minor midwestern state school.
The year was 2011.
The US was just coming out of recession.
The banks had gotten bailed out, again.
Whatever wealth was left, was concentrating on the coasts.
And the effects on recent college grads in 2011 in this region were clear: no new engineering
projects were to open in decrepit fly-over country.
As the economy tumbled, CW started reading about a new project called Bitcoin.
At first, he wasn’t sure what it was all about.
Paper money and fiat currency bad, he was told.
At the time, he couldn’t take it too seriously.
But he could run the program on his computer.
It would do math problems and confirm Bitcoin transactions, and he would get new coins every
day just from doing this.
At first he did this for gags and laughs.
Just the year before in 2010, someone sold 10,000 Bitcoins for 50 dollars, and another
person paid 10,000 Bitcoins for 2 pizzas, but just year later, 1 coin became worth twenty
US dollars.
CW couldn’t get a job after graduating college, but maybe he didn’t need one.
He already had thousands of bitcoins.
And if the price kept increasing, all of this would be more money than he’d get as an
engineer.
He mined as much Bitcoin as he could.
He built more computers with the fanciest graphics cards he could get.
The more computers running Bitcoin, the more coins he could mine.
The more he could overclock his graphics cards, the more coins he could mine.
And the more coins he could mine, the more money he’d make.
He became obsessed.
As the summer continued, a heat wave started going through city.
At first, CW procrastinated in installing air conditioning. His parents’ house didn’t have central air, so they had to install window units every year.
But things seemed ok.
CW would sit in his room in a tank top, with fans blowing everywhere.
His rigs were running hot but no problem, he was making good money.
One day, his room was over a hundred and ten degrees fahrenheit (43.3 C)
Usually CW would feel exhausted and tired in summertime, so this wasn’t out of the
ordinary.
One morning, CW woke up nauseous.
He got out of bed, and instantly felt dizzy.
It was hard sleeping the last few days with his Bitcoin rigs running loud and hot all
throughout the night.
As the day passed, CW couldn’t eat or drink anything because he’d feel like throwing
it up.
And without water, he developed a massive headache and could feel his eyes pushing out
of his skull.
He went to bed early, but in the morning, he didn’t wake up.
Karen thought something was wrong when she hadn’t seen her son all day.
As she goes into his room, she instantly felt the heat.
She sees her son slouched over on his bed, unresponsive, as she calls for 911 and he’s
brought to the emergency room where we are now.
Given this history of present illness, doctors have a few clues as to what’s happening.
At examination, CW had tachycardia.
Tachy meaning fast and cardia referring to heart rate.
His heart rate was fast, his breathing rate was fast, but his blood pressure was low.
His skin was hot and dry to the touch, and his temperature measured 106 degrees F (41.1C).
You want to be under 100 degrees (F), meaning that something terrible is happening in his
body at the moment, which give doctors the first clue.
CW’s belly was swollen, and a blood test finds that all of his organs, have started
shutting down.
Enzymes from the liver were found floating around in his blood.
If the liver is supposed to break down chemicals in your body, and it does that breakdown with
enzymes, then the reason those enzymes are floating around in his blood, is because his
liver cells have started dying, they’re spilling those enzymes into his body, as his
liver shuts down.
Waste products that are usually filtered by the kidneys, one called creatinine, which
comes from creatine used by muscles, was present in blood at a level 3 times higher than normal.
Nitrogens were found too.
If they’re high in the blood, then the kidneys aren’t filtering them.
Usually, nitrogen and creatinine have a ratio.
When the ratio is high, that could mean someone’s dehydrated.
CW didn’t drink much water over the last few days since he started feeling dizzy and
nauseous, so he was dehydrated.
But he wasn’t conscious to tell anyone this.
And this high ratio gives doctors some more clues as to what’s happening.
If CW is dehydrated and his body temperature is too high, then all of his problems might
just be because of heatstroke.
But, how long has this been happening?
It’s not good that he’s unconscious, because it means not only have his body organs have
shut down, but that his brain has shut down too.
Medical staff try to cool him down, because if they don’t, his organs will continue
to fail.
They submerge his body in ice packs, as they try to figure out why his body temperature
is so high.
CW is only 23 years old.
Usually, hyperthermia in a young man can come from overexertion.
Working out too hard during a hot and humid heatwave can impair the body’s ability to
waste heat through sweat.
If the air is already saturated with water because of humidity, there won’t be a meaningful
release of heat from the body through sweat.
This can raise the core temperature.
But CW wasn’t exercising; he was found unconscious in his bed.
How about stimulants?
Those can increase body temperature.
His mom Karen wouldn’t know if he had taken anything either.
But, he didn’t have a history of use and the toxicology screen came back negative for
everything, meaning CW really did heat stroke in his sleep, because his overclocked graphics
cards that were mining Bitcoin were generating so much heat in his room, during a heat wave,
and wouldn’t allow his body to dissipate heat.
But, wouldn’t his body have told him that things were too hot?
Would’t he have just woken up and gotten out of bed like most people?
Not necessarily.
CW was dehydrated, but he lost that water in the days leading up to his heatstroke.
Heatwaves don’t just last for one day, they’re several days long.
He hung around in his room with his overclocked computers mining Bitcoin.
He lost water while sweating in his tank top playing games.
He lost water while breathing.
And because he was dehydrated when he presented to the emergency room, it means he didn’t
drinking enough water to make up for the loss.
Do you remember that CW’s skin was dry and hot to the touch?
Well, it’s hard to sweat if you’re dehydrated, which is probably why he’s dry.
His heart starts to beat faster and harder to surface blood to his skin to dissipate
the heat that should have been lost using sweat.
Less blood goes to the organs, causing something called ischemia.
Isch from an Ancient Greek word meaning to hold back and emia meaning presence of blood.
A holding back of blood to the organs as blood pressure starts to drop because blood vessels
expand to try to get rid of that heat.
To make up for this and to keep pressure up, the heart tries to beat faster and harder,
but it’s not enough.
His core body temperature goes up again.
Enzymes start to denature because of the heat.
It’s like these eggs getting cooked as the proteins start to unravel.
The body needs those enzymes to break down food, to break down nutrients, to function
normally, but they don’t work anymore.
His organs aren’t getting blood flow anymore, so they’re getting starved of oxygen.
The kidneys can’t filter anything anymore.
The liver starts leaking enzymes.
The brain tries to compensate for the excess heat and decreased blood flow by opening up
its blood-brain barrier.
This leaks proteins in to the brain.
But that’s not the only thing going in.
As those proteins flow in, water follows too, swelling in to the brain.
This explains CW’s headache.
As the water presses in, it explains why he felt like his eyes were pushing out of his
skull.
All of this would be ok, except the brain is enclosed inside a hard space, the skull.
As the water keeps following the proteins in, the brain swells to a point where it crushes
up against the skull.
As the medical team checks up on CW, he’s starting to cool off.
But he’s not responsive.
Acids are found floating around in his blood, even after aggressive cooling.
Even after trying to give him fluids.
And he’s transferred in to the intensive care unit.
When he presented to the emergency room, doctors noticed that CW’s abdomen was swollen.
An abdominal X-ray found that parts of his bowels were dilated.
This could mean that something’s blocking it.
It could be a big deal, but maybe not.
So doctors thought to wait on it.
Over the next 2 days, CW stabilized.
His body temperature corrected.
His kidneys started functioning again.
And things were looking good.
Until the third day of admission.
At morning rounds, doctors found that CW suddenly developed a fever overnight.
His heart rate was high again, and his blood pressure was low again.
Physical exam revealed that CW’s abdomen was still swollen.
Another X-ray showed that something was causing his bowels to be dilated.
A CT scan showed that the walls of his small and large intestines have thickened, meaning
that parts of his guts are no longer alive.
But it’s not the only thing they found.
Scattered fluid and free air had accumulated outside his intestines, into the space where
his liver sits.
Meaning that not only are parts of his bowels not alive anymore, but that a hole was perforated
into his guts, and the contents were leaking into his abdomen.
But if he was dehydrated and heat stroked, and his body became like a furnace to shut
down his organs, how did it pop a hole in his intestines?
Well, this brings us back to ischemia.
Without enough blood going to his intestines because he’s dehydrated and because his
blood pressure is so low, his guts have to adapt.
Usually, they can survive this, but this increased stress means mitochondria in the cells have
less oxygen to work with.
Instead of being the powerhouse of the cell, they start to make reactive oxygen species
instead.
Nitric oxide, like what you’d find in some workout supplements designed to dilate your
blood vessels, is generated in the intestines, dilating the colon.
The walls of the bowels start to stretch, allowing bacteria to escape, causing endotoxemia.
Endo meaning from within.
Tox referring to toxins.
And Emia meaning presence in blood.
Toxins, from the gut, inside the body, floating around in the blood.
Extra insults where the leakage was happening, build up as the gut keeps swelling, until
a hole pops in the intestines.
CW was immediately sent in for surgery to see what was happening.
Surgeons found perforations in his large intestines.
What was supposed to be moving through those intestines, had leaked into his abdomen.
An infective coating was found, lining his intestines, along with dead tissue.
Surgeons had to remove parts of his bowel, and sew together the remaining parts.
After surgery, in the recovery room.
CW’s condition starts to stabilize.
No more liver enzymes are found in his blood.
His kidney function returns to normal.
His blood pressure and heart rate are just fine.
As he seems to make a recovery.
He regains consciousness.
But at examination, doctors find mild motor dysfunction, meaning he has some trouble controlling
movements.
Several months later, at follow up, doctors find that parts of CW’s brain that control
movement, have atrophied, meaning they’ve started to shrink, as is common in heat stroke
cases where the person wasn’t cooled down in time, just like CW.
Although his brain damage was mild, it is permanent, as he vowed to never mine another
Bitcoin ever again.
Personal details of the case from my own experiences in 2009 and clinical details of CW’s heatstroke
case as one I remember from 2012 Chicago.
Heatstroke is serious, and sometimes you don’t realize it’s happening because your body
has adapted to the environment you’ve been in, regardless of your age.
So stay well hydrated in the summer time.
Stay in the shade, and keep your body cool.
Take care of yourself.
Thanks so much for watching.
And be well.