Man dared to
drink quart of
soy sauce almost
dies from salt
poisoning
Workers inspect bottles of Kowloon Soy Sauce at their factory in the New Territories area of Hong Kong on December
15, 2008, one of the oldest companies making the sauce using traditional methods. TED ALJIBE/AFP/GETTY
IMAGES
A young man who drank a quart of soy sauce went into a coma and nearly died
from having too much salt in his body, according to a recent case report.
The 19-year-old, who drank the soy sauce after being dared by friends, is the first
person known to have deliberately overdosed on such a high amount of salt and
survived with no lasting neurological problems, according to the doctors in
Virginia who reported his case. The case report was published online June 4 in the
Journal of Emergency Medicine.
Too much salt in the blood, a condition called hypernatremia, is usually seen in
people with psychiatric conditions who develop a strong appetite for the
condiment, said Dr. David J. Carlberg, who treated the young man and works as an
emergency medicine physician at MedStar Georgetown University Hospital in
Washington, D.C.
Hypernatremia is dangerous because it causes the brain to lose water. When there
is too much salt in the bloodstream, water moves out of the body tissues and into
the blood by the process of osmosis, to try to equalize the salt concentration
between the two. As water the leaves the brain, the organ can shrink and bleed,
Carlberg said.
After the man drank the soy sauce, he began twitching and having seizures, and the
friends took him to an emergency room. That hospital administered anti-seizure
medication, and he was already in a coma when he was taken to the hospital where
Carlberg was working.
"He didn't respond to any of the stimuli that we gave him," Carlberg said. "He had
some clonus, which is just elevated reflexes. It's a sign that basically the nervous
system wasn't working very well."
The team immediately began flushing the salt out of his system by administering a
solution of water and the sugar dextrose through a nasal tube. When they placed
the tube, streaks of brown material came out. Within a half hour, they pumped 1.5
gallons (6 liters) of sugar water into the man's body.
The man's sodium levels returned to normal after about five hours. He remained in
a coma for three days, but woke up on his own.
For several days afterward, a part of his brain called the hippocampus showed
residual effects from the seizures. But a month after the event, he showed no sign
of the overdose: He was back at college, and doing well on his exams, doctors
reported.
A typical quart of soy sauce has more than 0.35 pounds (0.16 kilograms) of salt, the
researchers said.
Most cases of sodium overdose happen more gradually. In the 1960s and 1970s,
doctors actually gave salt to patients suffering from poisoning, to initiate vomiting,
until they realized its harmful effects.
Carlberg said he believes the young man survived because the team got his sodium
levels down so quickly.
"We were more aggressive than had been reported before in terms of bringing his
sodium back down to a safer range," Carlberg told LiveScience. Reducing sodium
levels more slowly has had poor or mixed results in the past, he said.
Strange but True: Drinking Too Much
Water Can Kill
In a hydration-obsessed culture, people can and do drink themselves to death.
June 21, 2007 |By Coco Ballantyne
© ISTOCKPHOTO.COM/GREMLIN
Liquid H2O is essential to life. Making up about 66
percent of the human body, water runs through
the blood, inhabits the cells, and lurks in the
spaces between. At every moment water escapes
the body through sweat, urination, defecation or
exhaled breath, among other routes. Replacing
these lost stores is essential but rehydration can be
overdone. There is such a thing as a fatal water overdose.
Earlier this year, a 28-year-old California woman died after competing in a radio station's
on-air water-drinking contest. After downing some six liters of water in three hours in the
"Hold Your Wee for a Wii" (Nintendo game console) contest, Jennifer Strange vomited,
went home with a splitting headache, and died from so-called water intoxication.
There are many other tragic examples of death by water. In 2005 a fraternity hazing at
California State University, Chico, left a 21-year-old man dead after he was forced to drink
excessive amounts of water between rounds of push-ups in a cold basement. Club-goers
taking MDMA ("ecstasy") have died after consuming copious amounts of water trying to
rehydrate following long nights of dancing and sweating. Going overboard in attempts to
rehydrate is also common among endurance athletes. A 2005 study in the New England
Journal of Medicine found that close to one sixth of marathon runners develop some
degree of hyponatremia, or dilution of the blood caused by drinking too much water.
Hyponatremia, a word cobbled together from Latin and Greek roots, translates as
"insufficient salt in the blood." Quantitatively speaking, it means having a blood sodium
concentration below 135 millimoles per liter, or approximately 0.4 ounces per gallon, the
normal concentration lying somewhere between 135 and 145 millimoles per liter. Severe
cases of hyponatremia can lead to water intoxication, an illness whose symptoms include
headache, fatigue, nausea, vomiting, frequent urination and mental disorientation.
In humans the kidneys control the amount of water, salts and other solutes leaving the
body by sieving blood through their millions of twisted tubules. When a person drinks too
much water in a short period of time, the kidneys cannot flush it out fast enough and the
blood becomes waterlogged. Drawn to regions where the concentration of salt and other
dissolved substances is higher, excess water leaves the blood and ultimately enters the
cells, which swell like balloons to accommodate it.
Most cells have room to stretch because they are embedded in flexible tissues such as fat
and muscle, but this is not the case for neurons. Brain cells are tightly packaged inside a
rigid boney cage, the skull, and they have to share this space with blood and other fluids,
explains Wolfgang Liedtke, a clinical neuroscientist at Duke University Medical Center.
"Inside the skull there is almost zero room to expand and swell," he says.
Thus, brain edema, or swelling, can be disastrous. "Rapid and severe hyponatremia causes
entry of water into brain cells leading to brain swelling, which manifests as seizures,
coma, respiratory arrest, brain stem herniation and death," explains M. Amin Arnaout,
chief of nephrology at Massachusetts General Hospital and Harvard Medical School.
While exercising, "you should balance what you're drinking with what you're sweating,"
and that includes sports drinks, which can also cause hyponatremia when consumed in
excess, Verbalis advises. "If you're sweating 500 milliliters per hour, that is what you
should be drinking."
But measuring sweat output is not easy. How can a marathon runner, or any person,
determine how much water to consume? As long as you are healthy and equipped with a
thirst barometer unimpaired by old age or mind-altering drugs, follow Verbalis's advice,
"drink to your thirst. It's the best indicator."
Viewer photo
Updated at 7:16 PM EST on Wednesday, Aug 27, 2014
If your dogs are anything like ours, they probably know that the smell of
sunblock equals a trip to the beach! What they don’t know, however, is that
drinking that salty surf can be hazardous to their health. Even small
amounts of seawater can cause a condition called hypernatremia, also
known as saltwater toxicity. Clinical signs of mild hypernatremia are often
limited to vomiting and diarrhea. However if your pet ingests larger
amounts of seawater, these signs can progress to lethargy, inappetance,
stumbling, kidney damage, seizures, neurological damage, and even death.
Hypernatremia can only be reversed with aggressive IV fluid therapy. If
you suspect your dog may have ingested saltwater, call your veterinarian
immediately.
Hypernatremia is dangerous because it causes the brain to lose water. When there
is too much salt in the bloodstream, water moves out of the body tissues and into
the blood by the process of osmosis, to try to equalize the salt concentration
between the two. As water the leaves the cells, the body tissues and organs can
shrink and bleed.
Water Intoxication in Dogs: Too Much
of a Good Thing
Posted: 08/06/2014 11:13 am EDT Updated: 10/06/2014 5:59 am EDT
Responsible dog owners understand the importance of making sure their canine companion
always has fresh, clean water to drink. But what a surprising number of pet owners don't
realize is that it's actually possible for a dog to ingest too much water.
Water intoxication, which results in life-threatening hyponatremia (excessively low sodium
levels), is a relatively rare but frequently fatal condition in dogs. At highest risk are dogs that
enjoying playing in the water for long stretches. But believe it or not, even a lawn sprinkler or
hose can pose a hazard for pets that love to snap at or "catch" spraying water.
What Happens When a Dog Ingests Too Much Water
Hyponatremia occurs when more water enters the body than it can process. The presence of
so much water dilutes bodily fluids, creating a potentially dangerous shift in electrolyte
balance. The excess water depletes sodium levels in extracellular fluid (fluid outside of cells).
When the sodium concentration in extracellular fluid drops, the cells start filling with water as
the body attempts to balance the sodium levels inside the cells with falling levels outside the
cells. This inflow of water causes the cells -- including those in the brain -- to swell. The
central nervous system can also be affected.
Symptoms of water intoxication include staggering/loss of coordination, lethargy, nausea,
bloating, vomiting, dilated pupils, glazed eyes, light gum color, and excessive salivation. In
severe cases, there can also be difficulty breathing, collapse, loss of consciousness, seizures,
coma, and death.
Dogs Most at Risk for Water Intoxication
Any dog can develop hyponatremia, however, the condition is most commonly seen in dogs
who will stay in the lake, pond or pool all day if you let them; pets that lap or bite at the water
continuously while playing in it; and dogs that swallow water unintentionally as they dive for
a ball or other toy.
The condition has also been reported in dogs that over-hydrate during or after exercise, as
well as those that enjoy playing with water from a garden hose or sprinklers.
Water intoxication can affect any size or breed of dog, but smaller dogs probably show
symptoms more quickly because it takes less time for an excessive amount of water to build
up in their bodies.
Treatment of hyponatremia in dogs typically includes IV delivery of electrolytes, diuretics,
and drugs to reduce brain swelling. With aggressive veterinary care, some dogs are able to
recover from water intoxication, but sadly, many are not.