Off-label use...
Yes, that's a camel to the left enjoying a refreshing bottle of Coca Cola. I consider myself quite the Coca Cola conoisseur, having spent many years in tropical countries where I was too scared to drink the water. I have fond memories of doing motorbike trips around Cambodia and stopping at roadside stalls to fuel up on Coca Cola (incidentally, in Cambodia, they often use old pop bottles to portion out gasoline). For some reason, whether it was the fact that they use cane sugar instead of high fructose corn syrup or glass bottles instead of cans, the Coca Cola always seemed to taste better. Even if it was served lukewarm in a dusty bottle. Coca Cola is currently the best-selling cola drink in the world. Interestingly enough, Coca Cola also reigns supreme as the most commonly used therapy in a small but important area of medicine: the unclogging of gastrostomy tubes. There's no scientific evidence to support the superiority of Coca Cola for this purpose over, say, Pepsi, RC Cola or any of the other coke beverages out there. Yet for some reason, it's touted by every preceptor I've ever asked and also even mentioned in some textbooks.
Presumably, the phosphoric acid in Coca Cola is repsonsible for its unclogging properties. Phosphoric acid is found in most carbonated beverages, though, including beer, and yet I've never seen a nurse pouring Guinness down a clogged gastrostomy tube. If we were to go on phosphoric acid content alone, it seems that Pepsi, containing 106.9 mg/L, would be a better choice than Coca Cola, which only has 106 mg /L.
Obviously, this is an understudied area of medicine which desperately needs some quality prospective evidence.
As a side-note, I've found that Coca Cola can also be used to unclog blocked sink drains.
Photo credit
posted by Liana @ 10:38 AM
15 comments
15 Comments:
I've always found it rather disturbing that something that so many people drink can be used to clean out drains. Blegh!
I would think that the real reason is the carbonation. Having no experience with gastrostomy tubes, I would imagine that the clogging is due to bits of debris of animal or vegetable origin, not mineral. Phosphoric acid is not especially good for disolving things, not even minerals. Phosphoric acid won't disolve cellulosic materials, nor proteins. It will dissolve glass, but not on the time scale that gastrostomy tubes need to be unclogged.
However, virtually all debris of vegetable and animal origin contains carbonic anhydrase. Carbonated beverages contain considerable carbonic acid and are metastable. When that carbonic acid hits your tongue, carbonic anhydrase reestablishes the equilibrium between CO2 and H2CO3 resulting in bubbles of CO2 forming.
In a mixture of debris and water, CO2 bubbles would tend to attach to the debris and float them up.
Most plugs contain significant porosity. The carbonic acid solution would diffuse into the plug, where contact with the carbonic anhydrase in the debris would release CO2 which would expand and tend to drive the outer layers of the debris plug away from the center of the plug. A steady stream of a carbonated fluid would thus tend to erode a plug of debris of vegetable or animal origin.
I would expect the important properties of an unclogging fluid to be CO2 content, absence of nucleating agents, and absence of agents that would inhibit carbonic anhydrase. I don't know what techniques are recommended, I would suggest that directing the flow of the fluid down a concentric tube of smaller diameter to the surface of the plug would be most effective. The carbonic anhydrase in the plug should release the CO2 which would carry the debris up the tube.
Uncooked leafy vegetable matter probably has the highest level of carbonic anhydrase. It might be a good practice to always ensure that what ever is put down the tube does contain sufficient carbonic anhydrase to facilitate unclogging should it be necessary.
"As a side-note, I've found that Coca Cola can also be used to unclog blocked sink drains."
When I first read that, I thought it said, "...can also be used to unclog blocked sink brains." I guess that's true too! I often use it on call nights to unclog my brain. :)
We used to use it at my cottage for taking the rust off the outdoor tap. Makes you wonder huh..
It's also a first-line treatment for a stuck food bolus (ie. for people who get a big hunk of something stuck in their esophogeus due to failure to chew their food). I've never had any luck treating these people with Coke, but some people swear by it, so I usually give it a shot (along with a couple of sprays of nitro) before asking someone with a scope to go fishing....
Dr. J.
Dr J, when you say "nitro", what are you actually refering to? I have considerable interest in nitric oxide physiology.
Phosphoric acid is a good rust remover. It forms a protective iron phosphate that then resists further corrosion.
Wow, I'm very flattered to see that people are still reading my blog (despite the conspicuous lack of posts over the past little while).
Daedalus2u, I was hoping someone with more of a chemistry background than myself would be able to comment on how Coca Cola works... thanks for setting me straight. Dr. J is referring to nitroglycerine spray... it relaxes smooth muscle and can relieve esophageal spasm.
Dr. J, I'd be curious to know what you'd consider the most common stuck food bolus. In my experience it's hot dogs.
Interesting, depending on diet, saliva can be nearly 1 mM in nitrite (after consumption of the nitrate in 100 grams of lettuce). In the stomach, the low pH can decompose that nitrite and make the stomach head space ~90 ppm NO (that is ppm, not ppb). That should relax smooth muscle too.
Gah! Too much chemistry!! :)
On a lighter note.
Without Chemicals, Life Itself Would Be Impossible.
When chemistry is outlawed, only outlaws will do chemistry.
Did you know that lime kool-aid will clean stains off your toilet or bathtub?
Hi Liana, The last stuck food bolus I saw was a large peice of cariboo. (For any non-veggies: Cariboo is delicious, lean, and very tender....highly recomended, but CHEW for the love of....).
As far as most common goes I agree that hotdogs and other tubular meats like sausages, and brawtwurst seem to be the most common.
Another interesting stuck food product of the north (though below the esophageous) is the seaweed bezoar.
Again....people....please....pretty please.....CHEW....
"tubular meats" hahahahaha...
Why do people insist on eating meat in "tubular" fashion when there are no parts of the animal (well, readily edible parts) that actually look like that?
I've found ginger ale (which is more commonly found on most nursing units) works just as well as Coke for clearing a G-tube. I think it's the carbonation as well.
I think the original reason for tubular meat was for preservation. Sausage is a way of storing meat long term, and consists of fermentation with lactic acid bacteria and nitrate. This generates low pH and nitrite which kills clostridia and turns the heme in myoglobin into nitrosyl-heme (which is the characteristic red color of nitrite cured meat).
The reason they were tubular was that the used intestines as the air-tight container to hold the material while it cured.
Lactic acid bacteria don't need O2, and reduction of nitrate to nitrite and to NO is best accomplished under anaerobic conditions. Lactic acid bacteria also make anti-bacterial peptides (bacteriocins) which aid in the preservation.
I think using a form like the intestines allowed more fat to be used, and allowed pieces that were too small to preserve in other ways to be saved.
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