Case study: Too much soy sauce puts teen in coma

The young man drank 56,000 milligrams of sodium, causing a life-threatening surge of salt in his blood.

Dave Yasvinski 3 minute read April 22, 2021
Soy sauce

There's such a thing as too much soy sauce. Getty

Each week we comb through science journals to explore a baffling medical issue.

With all due respect to cancer and heart disease, there may be no greater threat to the health of young men then the unfailing urge to blindly accept dumb dares from so-called friends.

Such was the case for a 19-year-old man from Virginia who earned an unenviable spot in the Journal of Emergency Medicine in 2013 by becoming the first known human to overdose on soy sauce and suffer no permanent neurological damage. Yes, soy sauce.

Not long after consuming a quart of the salty substance, the man began to twitch and suffer seizures, forcing those very same friends to rush him to the hospital, according to Live Science. By the time he made it to the emergency room, he was foaming at the mouth and had slipped into a coma.

“He didn’t respond to any of the stimuli that we gave him,” said David J. Carlberg, the emergency room doctor at MedStar Georgetown University Hospital in Washington, D.C. who treated the teenager. “He had some clonus, which is just elevated reflexes. It’s a sign that basically the nervous system wasn’t working very well.”

The bottle of soy sauce the patient poured down his throat contained in the neighbourhood of 56,000 milligrams of sodium, almost 40 times the daily intake recommended by Health Canada. The surge of salt in his bloodstream resulted in hypernatremia, a condition usually only observed in mentally ill patients with a penchant for salt. Hypernatremia arises when a person loses too much water or takes on too much sodium for the body to regulate. In an attempt to dilute the deluge, the body pulls water from surrounding tissues.

While excessive thirst is the main symptom of hypernatremia, extreme fatigue, muscle spasms and confusion are other telltale signs. In severe cases, water can be leached from the brain, causing it to shrink, bleed or have a seizure. If untreated, coma and death may not be far behind.

Doctors quickly administered their patient a cocktail of water and the sugar dextrose through a nasal tube, pumping six litres of the concoction into his system in 30 minutes. His sodium levels returned to normal over the next five hours and he emerged from his coma three days later without further intervention.

Salt overdoses usually occur more gradually, particularly prior to the 1980s when sodium was used to induce vomiting in people who had ingested poison, according to the case report. It can have such a detrimental effect in vast quantities that it was once used as a method of suicide in ancient China.


The study authors said they rarely encounter people with this much salt in their system. “The patient’s peak serum sodium was 196 mmol/L, which, to our knowledge, is the highest documented level in an adult patient to survive an acute sodium ingestion without neurologic deficits.”

“We were more aggressive than had been reported before in terms of bringing his sodium back down to a safer range,” Carlberg said.

While the patient’s hippocampus initially showed some residual effects from its soy-sauce seizures, within a month all signs of the overdose had faded away and he was reportedly back at school, performing well.

Dave Yasvinski is a writer

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