Soy Sauce Ingestion Led to Death

Brain CT after Soy sauce ingestion
Brain CT day 1 and day 3 of hypernatremia. Left panel: day 1 showing brain shrinkage. Right panel: day 3 showing brain edema

A 40-year-old died 8 days of ingesting 500 mL of triple strength Japanese seasoning soy sauce!

Approximately 0.75 grams to 3 grams of salt per kilogram of body weight can lead to death. The lethal dose of salt is <25 g, with serum sodium levels between 175 and 225 mEq/L. This case describes an incident where a 40-year-old female consumed 500 mL of triple strength Japanese seasoning soy sauce containing 2,393 mEq/L sodium chloride (NaCl).

A 40‐year‐old woman known case of schizophrenia presented to the emergency department (ED) with seizures. The patient had an altered level of consciousness 4 hours prior to the ED presentation. Approximately, 1.5 hours prior to the presentation, the patient had started convulsing.

Until few hours before the presentation, she was in perfect state of health and had no active medical concerns.

Her tonic‐clonic convulsions continued in the emergency department. Respiratory support with a bag valve mask was provided to the patient. Her heart rate exceeded 170 b.p.m with a fully palpable pulse. Her body temperature was >40.5°C and she was unconscious with a Glasgow Coma Scale score of 6 (E1V1M4).

The doctors gave her midazolam which stopped the convulsions; however, she remained unconscious. Therefore, the doctors immediately intubated her.

Serology revealed marked hypernatremia with a serum sodium concentration of 183 mEq/L and serum osmolality of 363 mOsm. The causes of hypernatremia were evaluated and the doctors did not find any cause for the patient’s convulsions and unconsciousness.

With further inquiry, the patient’s family revealed that she had ingested 500 mL of triple strength Japanese seasoning soy sauce containing 2,393 mEq/L NaCl.

To manage hypernatremia, the patient received 1,600 mL of Ringer’s lactate solution in the first hour. Subsequently, her serum sodium concentration decreased to 174 mEq/L. In the following 4 hours, she received 600–800 mL/h of 5% dextrose.

Five hours after admission, the patient’s serum sodium concentration decreased to 167 mEq/L.

Thereafter, the doctors adjusted the sodium correction rate to 0.5–1 mEq/L/h.

An initial brain computed tomography (CT) scan at the time of presentation showed brain shrinkage. However, another brain CT scan on the 3rd day revealed diffuse cerebral oedema with widespread low‐density areas.

On the 4th day of presentation, her electroencephalogram (EEG) was flat and brainstem reflexes had disappeared; thus, the doctors declared her brain dead.

On the 8th day, unfortunately, the patient died.

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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