the original video is here: 一位男人喝下了可疑的椰子水

? hello everyone, I am Dr Bernard,
? this case was published in literature, happened in Europe, but they were able to better understand what happened because analogous cases as well as the poisoning itself is more well documented in Chinese medical literature,
? hope you enjoy the video and 一鍵三連
? a man drank suspicious coconut water for lunch, this is what happened to his brain,
? AC is a 39 year old man, presenting to the emergency room, unconscious, paramedics(救急隊(duì)員) tell the admitting nurse that they found him in his house sweaty(汗多), nauseous(惡心), with pale skin, and laying down in a crooked(彎曲的) position,
? earlier that day, AC was living his regular life, he was hungry for some food and when he looked, he found a sweet young coconut, sitting on his kitchen counter,
? this coconut is not like the hairy regular ones you find in the produce section at the grocery, its the one you buy to get delicious coconut water from,
? the low temperature of the refrigeration helps limit microbial growth, and that is important because some bacteria and fungi(真菌) enjoy and thrive(興旺) on the natural juices of this fruit,
? but, AC wasn't aware, he remembered that he had been seeing this particular coconut on his kitchen counter for at least the last month,
? as he poked the pre-made hole in, and started drinking, immediately as the coconut water touched his tongue, he knew something was wrong, the taste was so terrible that he spat it out, but not before he swallowed some of it,
? he noticed there was a smell coming from inside the fruit, he tried cutting it open, and when he could finally look inside, he saw it was slimy(黏黏的) and rotten(腐爛), as he showed it to his wife, and threw it away,
? he kept rinsing(沖洗) his mouth because the taste lingering(滯留) in his mouth was so awful, but he was sure he completely washed it out,
? as the hours passed, AC started feeling funny, at first, he noticed he was sweating, but the room wasn't really that hot,
? he felt his palms were kind of damp(潮濕), maybe a little clammy(潮濕黏黏的),
? in the bathroom now, AC could feel a tinge(氣味) in his cheeks(臉), as a sour taste rushed into his mouth under his tongue, and he emptied his stomach into the toilet in a way like never before,
? unsure of what was happening, he looked in the mirror, and noticed that his complexion(膚色) was a pale, gray color, but the image that he saw in the mirror was starting to not make sense,
? as he stumbled out of the bathroom, he losesd his balance, on the floor now in a crooked position, not knowing where he was, not knowing what was happening, he was able to summon enough strengh to call for 911,
? in the ambulance, paramedics noticed that AC could still respond to questions, but it took hime some time before he cuold speak his response, but as he's brought to the emergency room, AC becomed unresponsive,
? at examination, doctors found that AC's heart was still beating, but his blood pressure was high,
? when they shined a light into his eyes, his pupuls(瞳孔) could still react and constrict, all of this meaning that at least one part of his brain was still functioning, for now,
? a blood test found that AC has metabolic acidosis(酸中毒),
? "acid" in the context being a waste product of metabolism, or cellular activity, but formally known as te concentration of hydrogen(氫) ions(離子) in his blood,
? and "osis" meaning a disorder of excess acid due to cell activiry,
? but whch cells are doing this?
? the medical team noticed that AC's forearms and his calves(沒有查到字典有小腿的意思) would randomly jerk(抽搐). given that he was found by paramedics in a twisted and crooked position, there could be something wrong with his muscles, but the nervous system controls the muscles, so which one has the problem?
? in the intensive care unit, AC's body temperature is now higher than when he presented to the emergency room, if he has acid in his blood because of abnormal metabolic activity, he quickly became unconscious in the ambulance, his muscle are twitching randomly, and he now has a fever, then this could mean that AC has an infection that's somehow affecting his brain called meningitis(腦膜炎), ?
? "itis" meaning inflammation of the meninges, layers of membrane(膜) surrounding the brain
? and metabolic activity causing acidosis might not be a problem with his cells in reaction to the fact that bacteria is now growing in his nerves and his brain,
? but how can the medical team be sure that this is what was happening?
? doctors sent a needle into his back to collect cerebrospinal(腦脊髓) fluid to test, if bacteria is infecting his brain, this fluid should give some clues that something is growing inside,
? but time was quickly running out, the medical team did not know for sure if he had an infection,
? they started him on antibiotics in hopes that if this was an infection, some of the bacteria can start to be handled immediately,
? what doctors also did not know about, is the suspecious coconut water that AC drank, he could not tell them about it because he was unconscious,
? his wife told doctors that AC had showed her a rotten coconut just hours before she found him crooked and sweaty on the floor, and this gave doctors some clues as to what was happening, because as the labs returned for the cerebrospinal fluid, it looked like there was not any infection in AC's brain at all,
? when a fruit becomes rotten, it's anyone's guess as to know what kind of bacteria and fungus(真菌) were growing and thriving(繁榮) inside,
? in medical literature, rotten coconuts and corn have been associated with BongKrekic acid(米酵菌酸。沒有字典有這個詞), a mitochondrial(線粒體) toxin that is made by Burkholderia bacteria, which sometimes appears as a result of incomplete fermentation(發(fā)酵),
? this gave us a couple of clues, first is that a rotten coconut that is slimy on the inside likely has bacteria and other microbes growing in it,
? if AC consumed part of rotten fruit, and that particular fruit had microbes growing in it, and those microbes can produce mitochondrial toxins, and the mitochondria is the powerhouse of the cell but can't be, because a toxin is prevent it from performing cellular metabolism, resulting in AC's metabolic acidosis, then all of this should make sense,
? except, when the coconut was tested, the lab couldn't find any Burkholderia bacteria, they tried multiple different tests, and even tried to look for bongkrekic acid itself, but none of it was found,
? an MRI(核磁共振) of AC's brain revealed that fluid had been swelling into his brain, particularly in the parts that control movement, learning, and memory,
? a blood test found that he had hyperrammonemia(高血氨),
? "Hyper" meaning high, "ammon" referring to ammonia(氨), a chemical made as a result of the body breaking down proteins, and "emia" meaning presence in blood,
? high ammonia presence in blood,
? proteins are large compared to simple molecules, they are long chains of simple chemicals, so the body can chop them down, to digest and handle them, gut bacteria do that digestion,
? each chain link in any protein are called amino acids(氨基酸), "amino" referring to the chemical group, "amine", which contains nitrogen,
? life on earch all require nitrogen, it's why you hear needing nitrogen in the soil with fertilizer, and from an ecosystem perspective, the exoskeleton(外骨骼) on some bugs contain chitin(幾丁質(zhì)), which is a significant container of nitrogen,
? if nitrogen is the essential part of amino acids, which is what proteins are made of, and the body needs to break down those proteins to get the nitrogen in order the function, then it makes sense as to why our bodies normally make ammonia, because that is the simplest nitrogen chemical that can exist, but it also makes sense as to why AC has hyperammonemia,
? the liver requires a lot of energy to function, if AC somehow ingested a mitochondrial toxin from suspecious, rotten, coconut water, it could prevent his liver cells from producing the energy needed to handle ammonia flowing in from his gut,
? AC's brain, also an organ needing lots of energy to function, was already impaired because of the toxin, but as extra ammonia started floating around in his blood, because his liver shuted down, it got into the brain,
? it caused fluid to start to swell in, meaning as AC's brain started shutting down, his liver shutting down made it even worse,
? but it's not his only problem, the same blood test found that parts of AC's muscles had broken off and started spilling into his blood, likely because his brain had trouble controlling the contraction and relaxation of his muscles, and because muscle tissue is also energy dependent, this should make sense,
? those muscle remnants(殘?jiān)? collected in his kidneys and ripped apart the tubules(腎小管), causing his kidneys to shut down too,
? the medical team noted, AC did not? have meningitis, he did not appear to have any bacterial infection, the rotten coconut from where he took a sip of the suspicious water also didn't have the Burkholderia bacteria that would make the bongkrekic acid mitochondrial toxin that could cause all of his problems, but given that his brain was swelling with fluid, his liver had shut down, and allowed ammonia to spill everywhere in his blood, parts of his muscles had sloughed off, and were now floating around in his blood caused his kidneys to shut down, what else could have been in that coconut?
? in the lab, further examination of the coconut found the presence of the fungus(真菌。此詞結(jié)尾就是s，不是復(fù)數(shù)) are arthrinium(沒有字典有此詞) saccharicola(沒有字典有此詞)(蔗生節(jié)菱菌) , known to produce the toxin-3-nitro propionic(丙。沒有字典有此詞) acid(丙酸),
? in the mitochondria, this toxin is shaped lika a chemical that's normally used to help produce ATP for energy, when the toxin is present, instead of the mitochondria using the normal chemical, the 3-nitro-propionic acid slides in and prevents energy production,
? as cells of the brain, especially in the areas that control movement, start to panic and run out of energy, some of those cells start to die,
? muscles cant be controlled properly anymore and they did not? have sufficient energy to function, as they started to float around in the blood,
? the liver cells also started to die quickly, and ammonia can't be handled anymore, caused the brain to swell(腫) even more,
? all of these happening because AC unfortunately drank suspecious water from a rotten coconut that had mold(霉菌) growing in it,
? 24 hours after AC presented to the emergency room, a scan of his brain shoed severe swelling,
? because the brain is enclosed inside a hard space, the skull, there is only a limited amount of space for it to swell before it starts to crush up against the sides of the skull, and ooze(漏) through the sutures(縫) or the cracks(裂縫) in the skull,
? and on the scan, it looked like his brain herniation(漏，專指內(nèi)臟漏了) was impending(迫近),
? AC's pupils no longer responded to light, reflexes that would show that brain stem still conducted and communicated signals in the body, were no longer in tact,
? AC could no longer breathe for himself and at 26 hours after admission, the medical team needed to make a decision with his wife whether to continue treatment,
? when it comes to food, especially fresh produce fruits and vegetables, it's important to keep them fresh, if they need to be refrigerated, refrigerate them, be cautious with expiration dates,
? that's not to say go overboard and throw everything in sight away because you heard of one video online talking about someone getting catastrophically(悲劇的) ill from drinking suspicious coconut water,
? but if something looks weird, something smells weird, something tastes weird, just be careful, sometimes, it isn't even the bacteria or the fungus growing on the food that can cause problems, but the fact that those microbes could produce chemicals that are toxic to humans, that is what can cause some issues,
? it's not common, nad sometimes accidents happen, and relatively exotic(外來的) things, like drinking from a coconut can lead to mistakes, just like in AC's case,
? at autopsy(尸檢), bleeding was found in AC's brain, reexamination of the coconut and a sample of his blood found the 3-nitro-propionic acid mitochondrial toxin, that was responsible for everything that happened to him,
? this toxin was something made by the arthrinium saccharicola fungus that was found in the rotten coconut from which AC had a drink of this suspicious water,
? thanks so much for watching, take care of yourself, and be well,
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