A hell of a lot of soy sauce

[TallScrubs]

http://www.ncbi.nlm.nih.gov/pubmed/23735849/

L;DR (link; didn't read): 19 year old male presents to ED after ingestion of 1 quart of soy sauce with corrected sodium of 190; tx with 6 L hypotonic fluid over 30 minutes. No neuro deficit

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[deuist]

I read the article. They don't mention what caused them to give 6L of D5W. But gawd! That's a lot of fluids to dump into somebody. The glucose jumped up to >1100 and the potassium dropped to 2.5 after all that sugar and free water was instilled.

 

[RPedigo]

6L is only like half the free water deficit, so oddly it's actually a little bit light. The 6L of D5W would have 300g of sugar, which is kinda crazy (1200kcal of pure sugar) but surprising that it would raise the blood sugar that high. Crazy case!

 

[dotcb]

This is actually contrary to what I learned and currently teach. That stable hypo and hypernatremia are slowly corrected by administration of isotonic fluids. Giving isotonic fluids still brings you toward the normal value. What they did in the article sounds like a recipe for a bad outcome (rapidly correcting a stable patient with hypotonic fluid). Anyone else think so?

 

[WilcoWorld]

This is actually contrary to what I learned and currently teach. That stable hypo and hypernatremia are slowly corrected by administration of isotonic fluids. Giving isotonic fluids still brings you toward the normal value. What they did in the article sounds like a recipe for a bad outcome (rapidly correcting a stable patient with hypotonic fluid). Anyone else think so?

Rapid correction of chronic, stable abnormalities is a bad idea. However, the patient in the case was acute (2 hours) and unstable (coma, seizure).

I interpret seizure as the trigger to get aggressive with sodium correction.

Still, 6L in 30 min - that's aggressive! But it does beg the question, what about dialysis?

 

[WilcoWorld]

One other thing - a 19 yo kid drinks a quart of soy sauce? Sounds like the world's worst bet. What'd he win for it, twenty bucks?

Edit: It happened in Charlottesville - UVA, almost certainly a bet.

 

[dotcb]

Sorry - I glossed over the coma, seizure part... But still - 6L of hypotonic fluid?

 

[RPedigo]

I think it's because of the known acuity of ingestion (and of course the symptoms). The risk of correcting hypernatremia is that if you have had it for any appreciable amount of time, the brain's cells will make little proteins (idiogenic osmoles, per this website it can be seen as early as 4 hours apparently) to balance the osmoles. Then if you correct the hypernatremia after this time, the brain's cells haven't had time to destroy those proteins and the osmotic gradient is to now rush fluid into the brain, leading to cerebral edema. That's my understanding of it, at least. In that case, rapidly correcting the known hyperacute hypernatremia to completely normal immediately wouldn't have any deleterious effects.

I agree though, even if it's known to be acute it doesn't make sense to rapidly correct it if the patient is asymptomatic because if you're wrong you could get yourself into some trouble...

 

[Birdstrike]

Good thread, actually. Add this one to this list of things not to do on a dare, to win a contest, or to get into a fraternity.

Roach-eating champion choked to death on bug parts, autopsy finds

"...choked on 'anthropod body parts' and his own vomit."

What did he win?

A snake.

http://www.miamiherald.com/2012/11/26/3114359/man-who-died-during-roach-eating.html#storylink=cpy

 

[Silent Cool]

http://www.ncbi.nlm.nih.gov/pubmed/23735849/

L;DR (link; didn't read): 19 year old male presents to ED after ingestion of 1 quart of soy sauce with corrected sodium of 190; tx with 6 L hypotonic fluid over 30 minutes. No neuro deficit

Reminds me of this:

http://www.cbsnews.com/2100-201_162-2358958.html

 

[Arcan57]

Good thread, actually. Add this one to this list of things not to do on a dare, to win a contest, or to get into a fraternity.

Roach-eating champion choked to death on bug parts, autopsy finds

"...choked on 'anthropod body parts' and his own vomit."

What did he win?

A snake.

http://www.miamiherald.com/2012/11/26/3114359/man-who-died-during-roach-eating.html#storylink=cpy

Oh Florida, is there anything that can't happen within your borders? I remember watching my hometown make an absolute farce out of the simple act of voting for president and thinking it was the most F'ed-up thing that would happen in the state. Little did I know...

#Floridaman

 

[smq123]

Oh Florida, is there anything that can't happen within your borders? I remember watching my hometown make an absolute farce out of the simple act of voting for president and thinking it was the most F'ed-up thing that would happen in the state. Little did I know...

#Floridaman

Best twitter feed ever: https://twitter.com/_FloridaMan

 

[smq123]

One other thing - a 19 yo kid drinks a quart of soy sauce? Sounds like the world's worst bet. What'd he win for it, twenty bucks?

Edit: It happened in Charlottesville - UVA, almost certainly a bet.

Sounds like it was a fraternity hazing/pledge thing: http://www.takepart.com/article/2013/06/07/dont-drink-quart-soy-sauce

 

[WilcoWorld]

Sounds like it was a fraternity hazing/pledge thing: http://www.takepart.com/article/2013/06/07/dont-drink-quart-soy-sauce

That's even worse.