Heme Review

Collaborator: Dr Katherine JohnsIf you don't need to put it in your body, don't put it in your body.These cases are patients who I, or my colleagues have seen. They are de-identified and many instances have been presented in more depth in an academic setting. These videos are not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet.References:A family cluster of nitrite poisoning, Suzhou City, 2013. Western Pac Surveill Response J. 2013 Jul 30;4(3):33-6. https://pmc.ncbi.nlm.nih.gov/articles/PMC3854094/Human safety controversies surrounding nitrate and nitrite in the diet. https://pubmed.ncbi.nlm.nih.gov/22487433/A mitochondrial superoxide theory for oxidative stress diseases and aging. https://pmc.ncbi.nlm.nih.gov/articles/PMC4306659/Proposed mechanism of nitrite-induced methemoglobinemia. https://pubmed.ncbi.nlm.nih.gov/15892615/Methylene Blue. https://www.ncbi.nlm.nih.gov/books/NBK557593/Methemoglobinemia. https://www.ncbi.nlm.nih.gov/books/NBK537317/Methylene Blue in Goldfrank's ToxicologyPriapism. https://www.ncbi.nlm.nih.gov/books/NBK459178/Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction. https://pubmed.ncbi.nlm.nih.gov/15198160/Pharmacologically-induced Recreational Priapism: Case Report and Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC7676772/PharmGKB summary very important pharmacogene information for G6PD. https://journals.lww.com/jpharmacogenetics/citation/2012/03000/pharmgkb_summary__very_important_pharmacogene.8.aspxThe Methylene Blue Baby. N Engl J Med 1989;320:1756-1757. Methylene blue as an antidote for poisoning. J Lab Clin Med. 1933;19:166–71.Methylene blue for distributive shock: a potential new use of an old antidote. J Med Toxicol. 2013;9:242–9.A review of methylene blue treatment for cardiovascular collapse. J Emerg Med. 2014;46:670–9.The role of monoamine oxidase inhibitors in depression treatment guidelines. https://pubmed.ncbi.nlm.nih.gov/22951237/FDA to Revoke Authorization for the Use of Red No. 3 in Food and Ingested Drugs. https://www.fda.gov/food/hfp-constituent-updates/fda-revoke-authorization-use-red-no-3-food-and-ingested-drugsMethylene Blue in the Treatment of Poisonings Associated with Methemoglobinemia. https://www.nejm.org/doi/abs/10.1056/NEJM193306012082205Lawmakers Press Amazon on Sales of Chemical. https://www.nytimes.com/2022/02/04/technology/amazon-suicide-poison-preservative.html

Original Report: https://www.nejm.org/doi/abs/10.1056/NEJMc2500231

References:Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. https://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/Establishment of the Nichols strain as the type strain of Treponema pallidum. https://pmc.ncbi.nlm.nih.gov/articles/PMC11868658/In vitro assay to demonstrate high-level erythromycin resistance of a clinical isolate of Treponema pallidum.. https://pmc.ncbi.nlm.nih.gov/articles/PMC172128/Phylogenetic and genetic characterization of Treponema pallidum strains from syphilis patients in Japan by whole-genome sequence analysis from global perspectives. https://pmc.ncbi.nlm.nih.gov/articles/PMC7862685/ Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. https://pmc.ncbi.nlm.nih.gov/articles/PMC8612932/Near-Universal Resistance to Macrolides of Treponema pallidum in North America. https://www.nejm.org/doi/full/10.1056/NEJMc2314441

Chubbyemu video: https://open.spotify.com/episode/5BXEnVu8h0UWvlfmkwy3Xv?si=1XFT34Q9Q06okvMB2UgNKg

Selected References:

Intravenous mushroom poisoning. https://pubmed.ncbi.nlm.nih.gov/4025991/

The inhibition of mitochondrial cytochrome oxidase by the gases carbon monoxide, nitric oxide, hydrogen cyanide and hydrogen sulfide: chemical mechanism and physiological significance. https://pubmed.ncbi.nlm.nih.gov/18839291/

Clinical toxicology of cyanide. https://pubmed.ncbi.nlm.nih.gov/3526995/

Probing the oxygen binding site of cytochrome c oxidase by cyanide. https://pubmed.ncbi.nlm.nih.gov/7929065/

Colchicine Gout Approval 2009 https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=022351

Chubbyemu is on Spotify now!

Chubbyemu Licorice Video: https://open.spotify.com/episode/77z8mZGbmBI4E2JtA8GXsh?si=k_qV_IkrQiqTGpn8EXK61Q

References:

A bradykinin-potentiating factor (bpf) present in the venom of bothrops jararaca. https://pmc.ncbi.nlm.nih.gov/articles/PMC1704050/

UpToDate, Choice of drug therapy in primary (essential) hypertension.

Primary Hyperaldosteronism. https://www.ncbi.nlm.nih.gov/books/NBK539779/

NEJM Case 24-1992.

Dr Pavlos Msaouel: https://faculty.mdanderson.org/profiles/pavlos_msaouel.html

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 @chubbyemu  energy drink video ► https://youtu.be/tAtaIZD0Ebs

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A Mom Ate 5 Day Old Sushi 🍣 ► https://youtu.be/R0d6Dpx2li4

Vitamin B12 deficiency can cause neurologic problems. It's stored in the liver and isn't made in humans. It needs to be sourced via diet.

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Loxosceles gaucho by Halies

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References:

CMS Malaque, RS Vetter, M Entres. Loxosceles spiders. Critical Care toxicology. https://link.springer.com/referenceworkentry/10.1007/978-3-319-17900-1_119

Myth: Idiopathic wounds are often due to brown recluse or other spider bites throughout the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071166/

Correspondance: Bites of the Brown Recluse Spider. https://www.nejm.org/doi/full/10.1056/nejm200505123521922

Spider Bites: Part 1. https://lacerationrepair.com/wound-blog/spider-bites/

Brown Recluse Pest Management Tips for The Spider That's Not As Common As You Think. https://entomologytoday.org/2018/01/29/brown-recluse-pest-management-tips-for-the-spider-thats-not-as-common-as-you-think/brown-recluse-range-map/

The Chilean Recluse. https://www.fdacs.gov/content/download/68159/file/Pest_Alert_-_Loxosceles_laeta,_The_Chilean_Recluse.pdf

Brown recluse spider (Loxosceles reclusa) envenomation leading to acute hemolytic anemia in six adolescents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902007/

Acute kidney injury and dermonecrosis after Loxosceles reclusa envenomation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119339/

Bites of Brown Recluse Spiders and Suspected Necrotic Arachnidism. https://www.nejm.org/doi/full/10.1056/NEJMra041184

Caffeine Dry Scoop: https://youtu.be/sylqJ0NEVJw

Happened while filming this video: https://youtu.be/LKNfFm0QDXQ

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References:

The Signaling Pathways Involved in the Anticonvulsive Effects of the Adenosine A1 Receptor. https://www.mdpi.com/1422-0067/22/1/320

Caffeine Withdrawal. https://www.ncbi.nlm.nih.gov/books/NBK430790/

A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. https://pubmed.ncbi.nlm.nih.gov/15448977/

Caffeine (1, 3, 7-trimethylxanthine) in foods: a comprehensive review on consumption, functionality, safety, and regulatory matters. https://pubmed.ncbi.nlm.nih.gov/20492310/

Coffee, CYP1A2 genotype, and risk of myocardial infarction. https://pubmed.ncbi.nlm.nih.gov/16522833/

In 2015, a boy rubbed an entire tube of minty pain relief cream in-between his legs, and it caused his organs to shut down. Majority of modern men I believe are familiar with this action-- you may have accidentally applied it to the area yourself, or to the eyes, where it will hurt for a time that feels like an eternity.

Chubbyemu video: https://open.spotify.com/episode/2ul5F6qQn8KoHlqfFFsXDz?si=u72E79cMSGaaSQIlaDEWEw

Boy Drinking his mom's essential oils: https://open.spotify.com/episode/4dmWDzHXAElQbsRuxN9roQ?si=LOXnN_FpTleDu83whkkJDQ

References:

Salicylate Toxicity from Exposure to a Methylsalicylate-Containing Rubefacient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786239/

Regional variation in percutaneous penetration of 14C cortisol in man. https://www.jidonline.org/article/S0022-202X(15)47268-9/pdf

Anatomy and physiology of chronic s pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503924/

Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. https://pubmed.ncbi.nlm.nih.gov/10634967/

ISPAD Clinical Practice Consensus Guidelines 2018: DKA and the hyperglycemic hyperosmolar state. https://pubmed.ncbi.nlm.nih.gov/29900641/

Guidance Document: Management Priorities in Salicylate Toxicity.  https://www.acmt.net/_Library/Position_Drafts/Management_Priorities_in_Salicylate_Toxicity_APPROVED_03_13_13.pdf

Tox and Hound – Unconscious Uncoupling – Managing pH in Salicylate Overdoses. https://toxandhound.com/toxhound/phinasa/

Salicylates. Goldfrank, Lewis R, and Neal Flomenbaum. Goldfrank's Toxicologic Emergencies. New York: McGraw-Hill, 2006.

Unconscious Uncoupling – Managing pH in Salicylate. Tox and Hound. https://toxandhound.com/toxhound/phinasa/

Counterproductive effects of sodium bicarbonate in DKA. https://pubmed.ncbi.nlm.nih.gov/8550770/

Peptic ulcer disease and non-steroidal anti-inflammatory drugs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398

Role of the mitochondrial permeability transition in salicylate toxicity to cultured rat hepatocytes: implications for the pathogenesis of Reye’s syndrome. Toxicol Appl Pharmacol. 1997;147:431–41. https://pubmed.ncbi.nlm.nih.gov/9439738/

Aspirin, acetaminophen and proton transport through phospholipid bilayers and mitochondrial membranes. https://pubmed.ncbi.nlm.nih.gov/1334228/

Fasting can be an effective tool for weight loss. However if used inappropriately, can result in some not good situations. The patient's situation in this case isn't quite like the intermittent fasting schedules that are popular today.

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References:

Mechanism of hypokalemia in magnesium deficiency. Huang CL, Kuo E. J Am Soc Nephrol. 2007;18:2649–2652. https://pubmed.ncbi.nlm.nih.gov/17804670/

Hypophosphatemia and Rhabdomyolysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC371889/

A Case of Hemodynamically Unstable Sick Sinus Syndrome Secondary to Refeeding Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148626

Review of the Refeeding Syndrome. January 2006 Nutrition in Clinical Practice 20(6):625-33. 

EMCrit Refeeding Syndrome https://emcrit.org/ibcc/refeeding/

Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008 Jun 28; 336(7659): 1495–1498. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/