Rohin Francis, MBBS, discusses the case of a 21-year-old university student who was drinking 2 liters of energy drink a day.
The following is a partial transcript of this video; note that errors are possible.
Francis: Tired all the time? Easily fatigued? Sleeping your way through life? Acaffoscaff RS is an exciting new treatment from Medlife Pharmaceuticals that may be just what you need.
Hi, my name is Dr. Kyle X. Treem. You might remember me from such dubious broadcasts as the 2012 Red Bull Snortathon and Monster Energy’s Ritual Sacrificial Games.
Are you tired all the time? Troubled by low energy? Looking for a quick fix to get your coursework done because you left it all till the night before your deadline? Unable to maintain a strong 24-hour live stream? Do you hate drywall? Are you insecure about your tragic attempt at a kickflip or just in possession of too many teeth? Ask your convenience store owner if a can full of sugar, caffeine, and all kinds of other random s**t is right for you.
I was a meek medical student not blessed with natural confidence. I drank alcohol occasionally at social gatherings, but tended to just fall asleep, until one day someone introduced me to a drink called a Jägerbomb. I woke up outside the dissection room some 9 hours later holding a sign for the women’s lavatory and missing half of my front incisor, with no recollection of what had happened and I thought, “this is what life should be about.”
Commercial Announcer: A can full of sugar, caffeine, and all kinds of random s**t, it is the most disgusting soft drink on the market. Side effects include anxiety, insomnia, hallucinations, dirtbikes, aggression, increased heart rate and/or blood pressure, poor fashion choices, arrhythmia, heart attacks, heart failure, and appearing on no less than two medical YouYube channels — simultaneously. Energy drinks can interact catastrophically when consumed with alcohol and led to lifelong regret. I mean, just look at this guy. What a loser.
Francis: Red Bull, Monster, 5-hour Energy, TENZING, Relentless, Rockstar … there is no end of energy drinks on the market.
Ignoring the Kyle memes, they are also wildly popular with many people: students, gamers, parents, night-shift workers. These are commonly drunk drinks, ironically not with extreme athletes. I know a handful of at least one-time, Red Bull-sponsored athletes and none of them drink it in private, which I think should tell you something.
Now, sugary drinks have a multitude of health risks when consumed regularly, which I’m sure you know all about. If you don’t, the one-line summary is that most soft drinks you can buy on the market, not just the fizzy ones, are full of sugar and it’s that refined carbs that are extremely bad for you in many ways — primarily things like weight gain, diabetes, heart disease, infections, poor dentition, and so on. Just drink water. I’m happy to be a paid shell for big dihydrogen oxide.
But this video isn’t about sugar, it’s about whether the whole list of ingredients in energy drinks has got risks. Right now, the long-term effects of these drinks are not well known.
A 21-year-old university student and teen gamer, previously entirely well, presented to the hospital with 4 months of shortness of breath on exertion, weight loss, and something called orthopnea, which is breathlessness when you lie flat. That happens when there is too much fluid on board in the body. When you lie flat, the pressure in the heart and lungs goes up, making breathing harder.
The excess fluid was apparent actually from the end of the bed because his legs had ballooned up with maybe 10 kilograms of additional water in the tissues … oh, sorry. For American viewers, 10 kilograms is the same as 10 septillionths the mass of Neptune.
But why would a 21-year-old man have excess fluid? If a normal person drinks loads of fluid, they’ll just pee it out. It won’t accumulate in the body. Normally that implies something is either wrong with the kidneys or the heart. For this young guy, both were in big trouble.
What was going on? It quickly became apparent this lad was seriously unwell. His creatinine was 562, urea 48, and he required bilateral nephrostomies for urinary obstruction. That sentence translated into English means his kidneys were so rogered that he required tubes inserted through his skin, directly into the kidneys, to allow them to drain.
This is his heart on admission. With every beat, only 9% of the blood inside the heart was being ejected forwards. What’s worse, both ventricles, the main pumping chambers, had blood clots inside them, which only happens when cardiac function is so catastrophically bad that blood moves so slowly that it actually clots.
Now, I’m sure I don’t need to explain that clots in the heart can be fatal because they can dislodge and travel anywhere, causing huge heart attacks or strokes. Indeed, he did suffer strokes, both from the clots, but also from his heart just not being able to generate enough pressure to get blood to his brain, so you get something called a hypoperfusion infarct, a stroke caused by a lack of blood. The toxins that had built up due to his kidneys not working had also affected his brain.
He was emergently started on dialysis and intensive care, and transferred to a specialist hospital for consideration of combined heart and kidney transplantation. This 21-year-old guy was spectacularly unwell.
When you’re confronted by a case like this, you need to do some “House”-esque detective work, except maybe not quite like House because about 90% of the tests he said were completely pointless and he wastes insane amounts of money.
But what House got right is the need for a very careful history. You need to ask more than just the usual questions of, do you smoke and do you have any medical problems. It was only when this was done that the answer became clear.
The most common cause for heart failure in developed countries is coronary artery disease, i.e., narrowing of the arteries in the heart, caused by cholesterol plaque and so on. But 21 years old, that’s way too young for that. Alcohol is another common cause, but he wasn’t a heavy drinker, at least not of alcohol.
Then you start thinking about things like myocarditis, viral infections, or inflammatory disorders of the heart. But none of that was found. However, a thorough doctor found out the patient had a bit of an addiction, slamming 2 liters, or 4 pints, of Monster a day.
(Watch the video above for the full discussion.)
Rohin Francis, MBBS, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won’t find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.