No, seriously. I don’t have any idea what this phrase actually means in medical terms. There’s a piece in the New York Times about how there’s a concern about Internet addiction in South Korea, and it brings up, once again, how young men are allegedly dying from “exhaustion” as they’re doing round-the-clock binges of World of Warcraft. Or Starcraft. Or Cyworld, or whatever it is they might enjoy playing.

I remember doing a quick literature search a little while ago, and I couldn’t find anything on the term — or, the underlying causes thereof. That is to say, “dying from exhaustion” is a little bit like saying “dying from a fever”. You don’t actually die *from* the fever, but the thing that is causing the fever and overwhelming infection.

Is it the sleep deprivation itself? Doubt it. There are many medical students and residents right now which might be up for 30+ hours in a row, and I myself have been up for almost 40. No reports of sudden death amongst us yet for those reasons.

Is it renal failure? Perhaps because they’re not drinking, which leads to dehydration? Also unlikely, as long as their thirst centers are intact, they’ll reach for something that should stave this off. As long as this isn’t a diuretic (something which makes you pee, and therefore dehydrated even more) this shouldn’t happen as well (well, see update below).

Is it a pulmonary embolus? Long hours of being stationary … somewhat analogus to being on a long-haul flight … that could be a risk factor for a clot. But even then, in otherwise healthy young males, this chance of this happening is highly unlikely. Its conceivable that some of them might have underlying and as-yet diagnosed predispositions to clotting, however.

Is it a sudden fatal arrhythmia? Perhaps triggered by the stress of sleep deprivation? Perhaps some of them had Brugada syndrome and didn’t know it — a cardiac disorder that afflicts young asian males, where they are prone to electrical disturbances of the heart which are lethal. If you survive this, congratulations — you get a combination implantable pacemaker and defibrillator.

Update: One conceivable way is through dehydration –> hypernatremia (imbalance of too much sodium) –> seizure –> death // or, renal failure –> hyperkalemia (too much potassium) –>  cardiac arrest.  See Mark’s comment below, where a Korean gentleman didn’t eat or drink for a few days.

If anyone has any other ideas, I’d love to hear from you. We’ve been hearing this phrase for so long now, as a cause of death being applied to Internet addicts. Its kind of vague — like saying they died of a cardiac arrest (everyone technically dies of a cardiac arrest eventually) without stating the underlying cause.

{ The tin-foil-hatted amongst us, however, might say that no one *actually* died, or that the death *wasn’t* because someone was sitting at an Internet Cafe; rather, these kinds of stories are disseminated with vague-but-seemingly-plausible-causes-of-death from centralized governments who wish to crack down on this less-than-desirable/productive behaviour }