[Cass]

The most House (the TV show)-like case that ever happened in my medical career was the case of the patient with liver failure due to green tea intoxication.

A young man presented in our hospital with acute liver failure. He'd just spent a month traveling through the rain forests of Brazil, Colombia and Peru. During his trip, he'd consumed unknown drugs in a Peruvian shaman ceremony and had unprotected sex with a Peruvian sex worker.

We tested him for everything obvious. He didn't test positive for any known drugs or any obvious drug-related toxins. He didn't have HIV. He didn't have hepatitis A, B, or C. He didn't have EBV, he didn't have CMV, he didn't have Dengue Fever, he didn't have Yellow Fever, he didn't have Malaria. He didn't have any sign of autoimmune conditions.

We called the institute for tropical diseases. We tested him for tropical diseases we'd never even heard of. He didn't have those. He didn't have Syphilis. He didn't have Gonorrhea. He didn't have liver cancer, or any other discernible cancers.

We called the institute for tropical diseases again. They started researching. We tested him for diseases the experts for tropical diseases hadn't even heard of. He had none of those, either.

His liver, which had started failing for no discernible reason, now stopped failing, for equally indiscernible reason. We started planning his discharge.

We had a nice final discussion. He really appreciated how hard we'd tried, he said, and he really appreciated how kind everyone had been, and sorry again about the unprotected sex with sex workers thing, that was effing stupid in retrospect. He said he was looking forward to getting home and detoxing from all this. He said he didn't think the green tea we had on the ward (cheap, shit, comes in bags, unlikely to have ever encountered a tea plant in real life) did anything much, detox-wise, and anyway he'd feel bad emptying our hot water carafe all the time.

Um. How much green tea do you drink, I asked him.

4 to 5 liters per day, he said.

I googled "green tea liver failure," with some vague memory that sometimes tea gets contaminated during the drying process and maybe he'd caught a bad batch? Turns out, green tea just... causes liver failures, occasionally, in higher doses. Probably due to the anti-oxidants.

You live and you learn.

The patient went home and limited his green tea consumption to no more than a cup per day. He checked in with me a year later, because I'd asked him for an update, and his liver was doing perfectly fine and had never failed him again.

[monkeynotes]

4-5 liters! Two liters of green tea typically contains over 400mg of caffeine which is the upper limit recommended for adults. This guy was consuming around 1g of caffeine a day.

[cassepipe]

I seem to remember that tea has another molecule that balances the negative effects of caffeine. Now let me try to find that information back...

EDIT: It's called theanine : https://fr.wikipedia.org/wiki/Th%C3%A9anine

[tdullien]

I regularly consumed in excess of 1g of caffeine during my early to mid 20s, either via coffee, green tea, black tea, or mate, or mixtures thereof. I don't think 1g is a very rare dose?

[LeifCarrotson]

No shame in missing something local among all the exotic red flags, but how does a person consume 4-5 liters of green tea per day to 'detox' while literally in a hospital? Isn't a fluids/diet survey part of admittance?

It's been a bit since my dad was in a hospital, but they wanted to know about literally everything that entered his mouth.

[Cass]

He didn't drink 4-5 Liters at the hospital, just a few (two or three) small cups per day. We'd asked about alcohol and drug consumption, but didn't think to ask about his normal food and drink consumption beyond asking for possible sources of infection (asking about any potential spoiled food or exotic meats he might have consumed.) In retrospect, certainly a big oversight in this case!

[reducesuffering]

That's quite circumstantial evidence though. Nothing in that story tells me you've accurately concluded that it was the green tea.

Patient had unknown liver failure and drank a ton of green tea. Liver failure went away while still drinking tons of lower quality stuff. He proceeded to limit high quality green tea without it coming back, but if it was unrelated it wouldn't have come back regardless if he limited green tea or not.

[Cass]

Oh, and I phrased that badly, but he didn't drink a ton of tea at the hospital. The hot water for tea comes in limited amounts from those samovar type things, and he didn't want to use too much of it, so he only drank 2-3 cups per day.

We were all burningly curious whether the liver failure would come back if he resumed his normal green tea consumption, especially him (very "try everything, you only live once" type of personality; see also, consumption of mysterious Peruvian rain forest drugs), thus proving whether the tea was the culprit or not, but for ethical reasons I had to caution him against experimenting on the only liver he had, and he reluctantly agreed he wasn't THAT curious. Therefore, the cause of his liver failure will never be fully and conclusively proven to be green tea.

[Cass]

Oh, certainly, there's nothing to prove it was the green tea. We did rule out any other cause of liver failure we possibly could, but there's nothing to say we didn't miss something. But green tea in high doses IS a known cause of liver failure (admittedly, not known to us at the time, but there's case studies on pubmed I found once I started searching), so it remained the most likely cause after eliminating anything else plausible apart from the good old doctor standby of "sometimes shit just happens, shrug emoji" also known as "idiopathic."