Acute renal failure! Scary term. Let’s get it out of the way. The story I am about to tell you involves acute onset kidney failure, which, I learned yesterday, is not fun. But I’m fine now so don’t worry.
It all started on Wednesday. I took my shot of Semaglutide (generic Ozempic) in the early afternoon. I’m supposed to take it every week, but I am not great about that, and this time, it had been almost three weeks since my last injection. A few hours later, I suddenly threw up an iced tea. Semaglutide, as I have written about, makes me nauseous, so this wasn’t very alarming. I’m sort of used to it by now. But Wednesday was worse than the other times. I was up all night drinking water and promptly throwing it up, but I kept saying to myself, no big deal. This will pass like it always passes. It’s probably just that you hadn’t taken it for a few weeks.
I have had some dental problems recently, and I’m on antibiotics, so I sort of figured maybe that was interacting with the Semaglutide and making it worse. Regardless, I was unfazed by the fact that by yesterday morning, I had been throwing up water for 12 hours. How unfazed? I was tweeting unrelated jokes the whole time.
But then, around 9 am, I suddenly felt an intense pain in my abdomen. This also didn’t immediately freak me out because I was like, Well, it’s probably just because of the stress of vomiting so much.
This is clearly something to do with dehydration, Ben, so what you need to do is drink water and keep it down. No matter what. Do not give in to the nausea and throw up. This proved impossible. I had not bothered even trying to eat food since that would be worse than water, but I figured some melon or something very watery might be worth trying.
Before I could actually go searching for fruit, a more concerning symptom developed. My legs essentially stopped working.
Leg cramps to an extent I had never experienced. My knees locked.
At this point, I am crippled, in immense pain, and dragging myself across the floor of my kitchen looking for fruit. The fruit plan—always a hail mary—is a failure and just results in me vomiting papaya on the floor.
I finally begin to consider the possibility that I should go to the hospital.
But because I am a stubborn idiot, I don’t actually do that. I keep hoping the nausea will pass and I will be able to drink water, which will solve everything. My legs don’t work, so I can’t drive myself, and I am temporarily frozen by worry that my health insurance won’t cover an ambulance ride. I also don’t want to freak other people out. Two more hours pass. Eventually, my mom gets me and drives me to the hospital.
By the time we get there, I have to be wheelchaired into the emergency room. One benefit of living in a small town is that though it was a 20-minute drive to the hospital, they see you pretty quickly once you’re there.
“What is going on?” the nurse asked me as he pushed me through the ER.
“The one thing I know is that I am dehydrated and need IV fluids. I will answer all of your questions after you give me fluids.”
When I was reporting my story about Ozempic in December, I spoke to doctors who told me that a very small number of their patients had ended up in the ER from dehydration. I had sort of assumed that those people had been unable to keep fluids down for multiple days. It did not occur to me that people could become this dehydrated in 16 hours or whatever it was.
The craziest part of all of this is the vampiric level of thirst that I began to have around 9 am on Thursday. I wanted water more badly than I had ever wanted anything in my entire life.
I explained all of this to the ER docs: I take this dumb shot to lose weight, and it makes me nauseous, but for some reason, this time, my reaction was much worse than normal, but all of these symptoms are clearly all downstream responses to the shot.
But the blood work they got back was so “weird” that they became concerned there was an underlying issue, which led naturally to more tests and CT scans.
What does “weird” mean? They were very unclear about this in a way that was obviously a choice. Slowly, over a few hours, it became clear that something was wrong with my kidneys. The results of the blood tests were just so abnormal that it meant my kidneys were not doing what they were supposed to do.
This was the first time in my entire life that I was a patient in an ER in a situation like this. In 2005, I was in a car accident and had all the tests in the world, but I was unconscious/barely conscious, and I have no memory of it.
I’ve been to the ER as a patient two other times but both times were basically just to get checked out after an accident. The last time I even walked into an ER was in 2022 when I carried someone else’s prostrated body into the ER because they had tried to kill themselves with an overdose.
So, part of me was sort of enjoying experiencing all of this for the first time. An IV bag, morphine, CT scans, etc.… I was particularly curious about the morphine because I have long felt like I am the only person in America who was apparently not prescribed Oxycontin for a headache in 2011. Multiple streaming shows have told me that Oxycontin is much stronger than morphine, but I still figured it would be a toe in the pool.
I imagine the doctors are just smart enough to do the dosage right, but I actually didn’t get high at all. It did do a good job of stopping the pain, though. And that triggered an endorphin high that made me sort of loopy.
Have you ever had a CT scan? They injected me with iodine ink so that the results were easier to see, which is a very interesting sensation. They kept warning me that I would feel it, and I kept being like, sure, sure. But you really do! It’s hot. I don’t know if the ink itself is hot or if the way it reacts to your blood creates a sensation of heat, but the feeling is that of hot liquid coursing through your veins. One of the more wild sensations I’ve ever had.
The CT scan showed that my kidneys looked fine and I didn’t need surgery. A peritoneal strand was wrapped around my intestines and choking it, and that was causing pain. Apparently, that is something that can happen when a lot of stress is put on your digestive system.
Fifteen zillion more blood tests showed my kidney function returning, which confirmed for the doctors that all of this was just my body’s reaction to the dehydration.
I honestly didn’t know I could get that dehydrated that quickly. Lots of people who live less fortunate lives than I do presumably have to go a day without water every once in a while. And it’s true that you can go a couple of days without dying. But, damn, it is way more intense than I expected.
I would have been better off if I had just not had any water. Instead, I kept drinking water and throwing it up, which added all this stress to my body and made everything worse. But, this experience has given me a new appreciation for characters in disaster films who have to walk through the desert with no water.
By yesterday evening, the tests were looking good and I was finally given some water. The water, which I had been begging for for hours, was the final test. If I could keep it down, they would let me go home.
I downed two delicious glasses of ice water. And promptly threw them up.
I thought about emptying the vomit bag and lying about this just to get out of there, but considering my awful instincts about this stuff lately, I felt it responsible to not lie to the doctors. Fortunately, an hour later, I was able to keep down water as long as I only sipped it.
The doctors were very relieved that I didn’t appear to have permanently damaged my kidneys. “They could have been permanently damaged that quickly?”
“Yes.”
This was honestly the scariest part of the whole thing. I had gone to the hospital because I couldn’t take the pain. At one point in the morning, I had considered smoking pot so that I could just go to sleep until the nausea passed. I didn’t do that because I hate smoking pot and always cough a lot, which I honestly wasn’t in the mood to do.
But at no point did I think I was risking permanent damage to my body. Eventually, the nausea would have subsided, and I would have been able to drink water, and I would have assumed I was fine, but it’s possible that I would have actually sustained permanent damage by then.
They gave me pills for nausea and handed me my discharge papers, which, for the first time, had the words “Acute Renal Failure.”
Kidney function, it turns out, is tidal: it comes and it goes.
The only mystery that remains is why I had such an extreme reaction to the semaglutide. There are some follow-up appointments with my actual doctor to figure that out and triple-check my kidneys. I might need to go off it, which would be sort of ironic since it has made me much healthier. The other possibility is that it was because of the antibiotics for my jaw infection or the extra few weeks that it had been since last taking the shot, and I just stay on it but take it with nausea medicine. There is apparently also a different GLP-1 that apparently doesn’t cause nausea as much, which they could try me on.
The whole thing has been a sort of interesting follow-up to that Ozempic piece, and part of me was tempted to hold off writing about it until I could think of a way to make it a proper article, but I felt like I owed it to everyone to give an update so people didn’t worry about me.
The moral of the story is that sometimes you should not avoid seeking medical attention until the last possible second.
Sometimes “calm down” is actually not the best advice.
Have a good weekend!
Love,
Ben
Many moons ago I worked for a telehealth company called Ask-a-Nurse. I don’t know how many people I spoke to who, like you, kept trying to force liquids when vomiting, which just extends the experience. The care instructions for vomiting I can quote from memory:
“Do not drink until you have gone at least 2 hours without throwing up. Then begin sipping on room temperature water slowly. If you try to force liquids too soon, it will just extend the time you are vomiting and increase the chance of serious dehydration.”
Room temperature because cold water slows the movement of the intestines, and can worsen nausea.
Also, when you are vomiting severely, you aren’t just throwing up what you put in, your also throwing up intestinal fluids which speeds up the process of dehydration.
I would suggest if the medication makes you nauseated, do frequent sipping of room temperature fluids before you throw up. Don’t down a glass of fluids all at once. You will get the same amount of liquid in and hopefully avoid vomiting.
One more thing. The instructions I quoted above are for actual illness (viral infection, food poisoning). You are going off fluids briefly to rest your intestines so they can calm down and accept liquids. Nausea and vomiting on Semiglutide is in large part from slowed intestinal movement (that’s how it works to decrease appetite). If you are sipping liquids because you’re nauseated and still vomit, it may not be necessary to wait the full 2 hours to try sipping again.
The empathy is strong on this one. A few years ago I'd been having some leg pains; thought it was the new mattress. Then one night I got the classic pain on the lower right, so off I went to the ER. There the pain subsided; they took X-rays, no problem with appendix, but my kidney values were wonky so I should call my urologist. (My diabetes has impacted my kidney function, so this wasn't really news. They didn't say HOW wonky)
This was Dec 22. The next day I called and made an appointment with a Urologist (I didn't have one on tap yet) for after Christmas. About seven that evening I was fixing dinner (no pain, no nausea, just odd "numbers") when I got a call--the urologist I'd never met. "How fast can you get to the hospital?" she asked. So I got a ride and they did a CT scan and I was scheduled the next morning (Christmas Eve) for putting in stents. Both my kidneys were completely blocked by stones. No nausea, no pain.
I was discharged Xmas day, and later went to have the stones removed. At THAT point I looked at the discharge papers. Yep, acute renal failure. Which I thought was a fun story. I'd had kidney stones twice before over the years and the pain was "I'd rather die" level, as was the vomiting. And here I have acute renal failure with nothing I could feel happening.
Fast forward 3 years. A stretch of mild nausea. My kids insist I have it checked out in ER. No pain. The nausea went away with an IV. The kidney values were uber wonky, so they send me for a CT scan and whoops, couple of big stones. I am waiting in the ER for a hospital bed (this was just post Covid) for about 12 hours. Just as one opens up, doctor does another round of blood tests: all is back to what is for me normal. Apparently I'd passed the stone, again, no pain, no nausea. They sent me home.
It was on the follow up visit with my by now familiar urologist that I got the shock. She said something about "now that only one kidney is working" and I said a polite medical version of "WTF!?!" She showed me. Years ago--discovered at the time of that first Christmas adventure--apparently one kidney had been completely atrophied by completely silent stones. She'd pulled those out, but my kidney was a goner. On a scan I later saw, it is literally the size of a kidney bean. And all my doctors--PCP, urologist, diabetes doctor,---thought someone else had told me.
So now I have a nephrologist and am stuck on something called a low oxalate diet, which means-- since I also have to be low carb and gluten free--that there is almost nothing outside of meat I can eat (and I keep getting nasty triglyceride numbers). Lettuce from now till I hit my 90s, I guess. But not spinach. And sadly, no more almonds, the worst oxalate offender, which had been my go to snack for years--low carb, gluten free.
With all this going on, I FEEL just fine. I just am under orders to go to the ER for every little burp of nausea or stomach pain. Luckily I don't get GERD. Thanks god Medicare can't drop me.