A TikToker Drank 1 Liter Cough Syrup. This Is What Happened To His Brain.

2020-11-02

[public] 2.04M views, 128K likes, 1.49K dislikes audio only

Chubbyemu

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Do not misuse cough syrup.

Codeine metabolism happens in the liver and is mediated primarily in the first pass by CYP 2D6 (to morphine) and CYP 3A4 (norcodeine). Codeine and morphine can be glucuronidated in a second pass of metabolism, but watch for renal function in hospitalized patients as morphine-6-glucuronide is renally excreted. Because it is pharmacologically active as an analgesic as well, use caution in patients with renal failure. Genetic mutations in 2D6 have been observed and result in different pharmacokinetics for codeine. See references below.

This case is 2 cases combined. Both are de-identified. This video is not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet.

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References:

Codeine with Ultrarapid CYP2D6 Metabolism. N Engl J Med 2004; 351:2827-2831. https://www.nejm.org/doi/full/10.1056/NEJMoa041888

Codeine after tonsillectomy in North American children. Pediatrics. 2012 May;129(5):e1343-7. https://pubmed.ncbi.nlm.nih.gov/22492761/

UpToDate: Cytochrome P450 3A (including 3A4) inhibitors and inducers

Codeine Therapy and CYP2D6 Genotype. https://www.ncbi.nlm.nih.gov/books/NBK100662

Pharmacokinetics of codeine and its metabolite in ultra-rapid metabolizers due to CYP2D6 duplication. The Pharmacogenomics Journal volume 7, pages257–265(2007). https://www.nature.com/articles/6500406

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Chubbyemu I make medical videos, telling stories in medicine. These are variations on cases I, or my colleagues, have seen in the past. The main goal of these videos are to tell a story about people, as we each have a unique story to tell. This channel was created in September 2015 as a way for me to create something I could call my own. The earlier videos served to teach me how to make a video, as I have no background in filming, editing, etc. That early content was following trends of the time, learning how best to approach my lack of understanding of video. I hold no responsibility over what you do with your or anyone's body after watching any of my videos. You should not recreate any of the presented situations. These videos are not and are not intended to be medical advice. I do not give individualized medical advice over the internet. I am a licensed provider trained and based in the United States.
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