一个月吃了1176片布洛芬

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the original video is here 一个月吃了1176片布洛芬

a man took 1176 ibuprofen tablets in a month, this is what happened to his kidneys,  SB is a 34 years old man, presenting to the emergency room with dizziness(眩晕), muscle aches, and fatigue(疲劳),   he tells the admitting nurse that over the last few days, when he would use the bathroom, he'd glance back into the toilet, and it would look like asphalt,   SB loved running, but sometimes his body would just hurt, "must be getting too old, he thought",   one day, while he was running he felt like his shin(胫骨) splints had returned,  splint在字典里只有“固定骨头的夹板”的意思，但是"shin splint"合在一起能搜出”胫骨痛“的意思，  it hurt to put any pressure on his legs,   给腿一点压力就痛，  ibuprofen was always his go to for when he thought he was sick or in pain,  不知道”go to for"有没有“首选”的意思，没有查到，  it's over the counter(非处方), "people take aspirin every day and it's basically the same medicine, it even comes in 1000 tablet packs,  "clearly, you're supposed to finish the whole pack of medicine for a full course, otherwise why would they sell it like this?"  he thought, as he followed the label and took 6 tablets every 24 hours with an extra one just for good measure,   at first, he would spread out the doses like the bottle said, but eventually, that was too cumbersome, so he'd take all 7 tablets at once, and nothing bad happened, he felt great,   he wasn't sure if his legs actually hurt anymore, but gotta finish that whole course, he thought,   one night, SB had forgotten that he had taken 7 ibuprofen in the morning, he had also forgotten that he had taken another 7 at lunch time, he had forgotten that he had taken 7 at dinner, as he put 7 more tablets into his mouth, for a total of 28 in a single day,   as he swallowed, he felt that these tablets didn't go all the way down, it felt like they were somehow stuck in his chest,   this isn't something to worry about, it'll all take care of itself, he thought, as he went to bed,  but a few hours later at 3 am, SB jumped awake, just under his chest was a terrible feeling, like a sharp object had plunged in and started twisting,  he wasn't sure if it was heartburn, but as the night continued, it did start to go away,  when he woke up, he wasn't sure if he was alright, but "ibuprofen is a pain reliever and I had pain during the night", "so the answer here was to take more",   how does ibuprofen know where the pain is? he thought as he went on like this for several days, consuming all 1000 tablets, and then he bought some more,   but then SB started to notice that he had difficulty swallowing, it felt like something was in his chest but he didn't know what,   he noticed that his stools were darker than normal, almost looking like asphalt, his stomach would start to hurt like it did that night,   he'd burp, and it'd hurt and it taste like blood,   one morning, SB felt especially weak, he thought it was kind of weird how every time he went to urinate, the volume was so much less than the amount of liquid that he drank,  he felt like he had the flu, but when he checked, he didn't have a fever,  as he stumbled into the bathroom, he looked in the mirror, he knew he was supposed to be looking at himself, but something didn't look right,   and as he burped, what was supposed to be gas, was blood,   as he calls for 911 and he's brought to the emergency room where we are now,  at examination, there were several clues to tell the medical team what was happening, because they had no idea of SB's ibuprofent excess, he didn't tell them about it because he didn't think it was a problem,   SB's skin was pale and he had tachycardia(心跳过快), "tachy" meaning fast and "cardia" referring to heart rate, his heart rate was fast,   but he also had orthostatic hypotension, "ortho" from ancient Greek referring to straight or upright, "static" also from ancient Greek meaning "fixed in place" but in this context referring to "standing", "hypo" meaning "low', and "tension" referring to blood pressure, his blood pressure would suddenly decrease when he stood up, but why was this happening?  SB told them about his hematemesis(吐血), and his stools looked like asphalt, both of these suggest that blood somehow got into his GI tract(胃肠道) and was digested,   his hemodynamic instability appear to be consistent with blood loss, his tachycardia was his heart beating faster to compensate for the less blood volume, and when he stood up, there just wasn't enough blood volume to keep his pressure normal,   clearly, SB has been suffering from some kind of blood loss due to a GI bleed, but why was this happening?  this brings us to a concept called dissolution(溶解), when you take a tablet or capsule by mouth, it has to get into the stomach so it can dissolve and absorb into the bloodstream,  do you remember that SB took some tablets and felt like they didn't go down all the way? well, sometimes, solid medicines taken by mouth go into the esophagus(食道), and they just stay there, most of the time this shouldn't be a problem, the smooth muscle will get it down by a movement called peristalsis(蠕动), and tablets and capsules usually slide down when wet,   labels will often say take with a whole glass of water so you can wash it down, or you should take the medicine with food, something that will push it into the stomach,   but SB didn't do that, he went right to bed, and laid down, the tablets that he swallowed that night stuck against his esophageal mucosa(粘膜) and made contact for some time, but that's only the start of his problems,  ibuprofen is a non-steroidal(不是类固醇) anti-inflammatory(消炎) medicine,   sometimes, the "steroid" name confuses people, because it makes us think of anabolic(合成代谢的) steroids in body building(健美) and sports,   much more commonly in medicine, we use corticosteroids(皮质类固醇) as an anti-inflammatory,   inflammation is the immune system response to physical injury and infection to protect the body, but sometimes inflammation goes too far, it causes swelling when you don't want swelling, it causes fever when you don't want fever like for young children where high body temperatures can impact their brain,   and inflammation can cause pain, so anti-inflammatory medicines stop all of these from happening,   corticosteroids are based off of cortisol(皮质醇), which is a hormone naturally produced in our bodies to limit inflammation,   whenever you see a mention of hormones, know that they are chemical messengers in the body, and they are subject to natural feedback mechanisms, in order to limit their function and maintain balance in the body,   hormone feedback can be exceptionally difficult to manage, but ibuprofen is non-steroidal, it works in an entirely different way, which is a benefit at therapeutic doses(剂量),   but SB didn't take a therapeutic dose, he repeatedly took a toxic one over a month and this starts to explain all of his problems,   doctors send a camera down his throat to take a look at his GI tract, and they found ulcers(腐烂) in his esophagus and his stomach, these look like the canker sores in your mouth you sometimes get, except for SB, doctors noticed that his ulcers were bleeding,   "canker", "sore"都是“腐烂，溃疡”的意思，合一起就成了“口腔溃疡”，不懂，  they found the source of his blood loss, but why is this happening? this brings us back to the name "non-steroidal" anti inflammatory medicine,  steroids work very generally in humans, sending signals right to the immune system, but nsaids(非类固醇抗炎药) like ibuprofen, work very specifically,   inside almost every cell in the body is the enzyme cyclooxygenase(环氧便酶。没有英汉词典有收录), when you get tissue damage like a cut, cyclooxygenase makes a chemical called prostaglandin(前列腺素), and that draws the immune system in,   ibuprofen stops cyclooxygenase from working, so prostaglandin isn't produced, and the immune system doesn't react,   this should be ok, except prostaglandin does more than just draw the immune system in, in the GI tract, it helps inhibit stomach acid secretion(n. 分泌), it stimulates mucus(粘液) production, and helps with blood flow in the inner lining,   this explains why SB has ulcers, and why they're bleeding, because not only was ibuprofen physically stuck to the inner lining of his esophagus during that one night, but he had also been taking huge amounts of ibuprofen for so many days that there were no prostaglandins, and other ulcers formed, and worsened, and started to bleed, because of the sheer amount of ibuprofen that he was taking daily, do you remember SB thought that his ibuprofen was just like taking daily aspirin？  well, he was right in that they're both nsaids, but daily aspirin is 25% of a full dose of aspirin, whereas SB was taking overdose amounts of ibuprofen every day, the dose makes the poison,   but there's also the element of time, ibuprofen tablets take about 2 hours to go from the stomach into the blood, this brings us to an idea called half life,   when medicine is circulating in the body, some of it makes its way into the liver, where it's broken down or metabolized,   half life is the amount of time it takes for the drug level in the blood to be cut in half, for ibuprofen, it's 2 hours, because he took 7 tablets 4 times every day, the ibuprofen levels in his blood remained abnormally high for a very long time, it caused injury to the point of bleeding inside his stomachand his esophagus,   the blood loss caused his heart to become unstable, it constricted blood vessels going into his kidneys, preventing them from functioning and causing parts of them to start to die, this almost never happens at regular doses,   over the counter medicines can be dangerous when misused like this, it doesn't help that some of these medicines are sold in large bulk packaging, occasionally being misinterpreted by people as designed for a single course of medicine,   the label on the package will always tell you how to take it, when used properly, nsaids are effective anti-inflammatories,   ibuprofen is generally more effective as an analgesic, "an" meaning "without', and "algesic" referring to pain, compared to aspirin,  blood clotting is a kind of inflammation and platelets(血小板) are a kind of blood cell that are responsible for clotting, and they also have cyclooxygenase,   aspirin is better at working with clots than ibuprofen because it irreversibly stops platelet cyclooxygenase, unlike ibuprofen which is reversibly stops, so not as effective,   the GI side effects of nsaids are so well known, that you find things like enteric(肠子里) coated(涂层) aspirin, which helps limit contact with stomach and esophageal mucosa, and also liquid gel caps(液体凝胶帽，不知道是什么), which don't need time for dissolution in the stomach, they can dump a liquid bolus, quickly absorbed,   enteric coated aspirin, 阿斯匹林肠溶片。  generally, these medicines aren't as common for fever because of their known GI and kidney side effects, for fever, you usually take acetaminophen(对乙酰氨基酚), which can still be misused, but has a high therapeutic index, this brings to another concept called drug resistence(耐药性),  sometimes you are told if you take ibuprofen for headache too often, it will eventually just not work for you anymore, and that's not true, it's not an antibiotic where you're pitting drug therapy against a live organism, and the organism evolves to evade the medicine,   it's also not a habit forming medicine based off of this plant(视频所示罂粟), which can create a dependency based on the body adapting to it, if you're taking nsaid for pain spread out over a couple times a month, there's no rebound feedback mechanism, or adaptation in the body that will limit its efficacy(药效), I had to explain that to my own parents, because they had used to scare me out of taking headache medicine when I was a kid,     and the topic of nsaids can go on forever,   in the context of cyclooxygenase, there's multiple isoforms(亚型，同种异构) of it, and we've found medicines that inhibit only COX-2 instead of COX-1 for pain, and interestingly enough, one of them is named Celecoxib, "selective COX inhibitor", and it's analgesic without prominent GI side effects, bringing us back to SB,  in the hospital, the medical team pushed water through his body to rehydrate him, and to get flow back through his kidneys,   his bleeding ulcers were fixed,  字幕汉语说“他的出血溃疡通过灼烧闭合的方式解决了”，不知道“灼烧闭合”是什么，但是字幕英语好象只是说“他的出血溃疡好了”，  and the waste that was floating around in his blood because his kidneys had shutdown was managed,  只说处理了血中废物，没有说怎么处理的，   without knowing his baseline kidney function before he took all the ibuprofen, it's not known by how much exactly his kidney function decreased, or how permanent any damage done might be, but when the time arrived, massive urination preceded him being discharged from the hospital, as he was able to make a recovery,   this case was referred to me from a Chinese question and answer website(知乎), asking if ibuprofen really dose come in 1000 tablet packs in the United States,   every situation described in this video is one that I have seen myself,   relating to nsaid misuse, which unfortunately is common,   there's other situations that I didn't describe here, like patients taking multiple prescription(处方) nsaids, because they saw different primary care, and no one knows that the patient is doubling or tripling up their care,   so please do your best to be aware of what medicines you're taking, how much you're taking, how often you're taking them, and please try to stick with the instructions that are on the package label,   thanks so much for watching, take care of yourself, and be well.    

关键词： 口腔溃疡 ONEDAY MEANING MEDICINE TENSION 阿斯匹林 GENERALLY ASPIRIN SPLINT night CANKER WELL