Explained | How protein shakes triggered a teen's death, now prompt calls for life-saving warnings

In 2020, a 16-year-old Indian-origin schoolboy named Rohan Godhania from Ealing, west London, tragically suffered irreversible brain damage and died. The tragic death happened after he consumed a protein shake, but at the time, the exact reason could not be diagnosed.

Now, after the recipient of Rohan's liver began experiencing seizures, tests revealed that protein shakes triggered a rare genetic disease. This has now prompted a coroner to call for health warnings on supermarket-bought protein shakes.

Rohan's death and the rare genetic disease

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As per a DailyMail report, the teenager fell ill on August 15, 2020, after consuming the shake, and passed away three days later at West Middlesex Hospital.

Initially, the cause of his death, a rare genetic disease called ornithine transcarbamylase (OTC) deficiency, could not be determined as his organs were donated for transplantation before the underlying cause of his sudden illness was discovered.

Several months later, when the recipient of Rohan's liver began experiencing seizures, a biopsy was conducted on the organ, revealing that Rohan had OTC deficiency, an extremely rare genetic disorder that falls under the category of urea cycle disorders.

What is OTC deficiency?

It is a type of urea cycle disorder, a group of genetic disorders characterised by a deficiency in one of the six enzymes responsible for removing ammonia from the bloodstream.It is characterised by symptoms such as vomiting, refusal to eat, lethargy, and coma.

The inability to break down ammonia can lead to its accumulation in the bloodstream, causing potentially lethal levels, particularly when triggered by a protein load. OTC deficiency is incredibly rare, estimated to affect only one in 50,000 to 80,000 individuals.

Health warning is necessary, says coroner

On Tuesday, coroner Tom Osborne in his preliminary view expressed the need for health warnings on protein shake packaging.

As per DailyMail, he said: "Concerning these protein drinks, my preliminary view about them is that I ought to write to one of the regulatory authorities that some sort of warning ought to be put on the packaging of these drinks because, although OTC is a rare condition, it can have harmful effects if someone drinks and it causes a protein spike."

Professor Finbar O'Callaghan, a specialist in pediatric neurology at the Institute of Child Health, University College London, supported the call for intervention, and said that it can be "potentially life-saving".

The inquiry into Rohan's death and missed opportunities

During the inquest into the tragic death of Rohan Godhania, it was revealed that his organ was approved for transplantation despite the cause of death not being determined at that time. This fatal mistake led to the recipient of Rohan's organ developing a serious illness and prompteda connection to be made between the two cases.

An independent expert identified the link between the teen's death and the organ recipient's seizures after the latter was hospitalised with similar seizure symptoms.

Lawyers representing Rohan's family raised concerns about missed opportunities to screen him for ammonia levels before his death, despite it being a recommended procedure. They suggested that ammonia testing could have revealed his urea cycle disorder.

Professor O'Callaghan, speaking at the inquest, supported the lawyers' suggestion and said that if an ammonia test had been conducted when Rohan was admitted to the hospital, it was "possible" that he would have survived.

He also criticised the decision made by a specialist hospital, categorised as a tertiary centre, to reject the referral for Rohan to their pediatric neurological team based on the classification of his age by West Middlesex Hospital as an adult patient.

Adult patientor a pediatric one?

The professor argued that Rohan, like other patients his age across the country, had fallen into a gap between pediatric and adult care, resulting in a lack of quality care."I am critical of the fact that if he (Rohan) goes down that adult pathway, he was refused admission to the tertiary hospital because he was 16 years of age."

According to Professor O'Callaghan, if Rohan had been treated as a pediatric patient, he would likely have received a prompt and accurate diagnosis and experienced a smoother healthcare journey.

"If a hospital doesn't have an adequate pathway for treatment, say if it cannot guarantee that 16-year-olds get accepted at the tertiary hospital, then that's a big problem," he added.

He further expressed his disapproval of the situation where a patient's admission to a hospital becomes a subject of discussion, stressing that there should not be debates regarding whether a patient should be admitted to a pediatric hospital or an adult unit.

"This is a problem within our health service. The discussion goes on far too frequently around the country and the danger is that when there is uncertainty or debate, then the patient suffers, as I think has happened in this case," he remarked.

Dangers of protein powders

A 2022 report bythe Clean Label Project, a non-profit organisation, found the presence of toxins in protein powders. The study which involved the screening of 134 protein powder products for 130 different types of toxins revealed that many of the tested protein powders were found to contain various contaminants, including heavy metals like lead, arsenic, cadmium, and mercury, as well as bisphenol-A (BPA) and pesticides. These contaminants have been linked to the development of cancer and other health conditions.

(With inputs from agencies)

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