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.