It was the Bizarre Case of the Soy Sauce Overdose. According to a report published in the Journal of Emergency Medicine, a 19-year-old man barely survived after drinking a quart of soy sauce. The teenager’s friends had dared him to consume the sodium-rich liquid. Within minutes, the extreme amounts of salt prompted seizures, followed by complete unresponsiveness. The patient’s friends brought him to the emergency room of the University of Virginia Medical Center, where physicians began treatment. “He didn’t respond to any of the stimuli that we gave him,” said Dr. David J. Carlberg, who treated the patient, in an interview with LiveScience. “He had some clonus, which is just elevated reflexes. It’s a sign that basically the nervous system wasn’t working very well.” Carlberg diagnosed the issue as hypernatremia, a condition that typically occurs in older people who don’t drink sufficient amounts of water. Hypernatremic patients have high levels of sodium ions in their blood supply, which prevent several body systems from functioning effectively. It’s also characterized by brain cell shrinkage, eventually leading to bleeding in or around the brain. If left unchecked, hypernatremia can cause permanent brain damage, circulatory problems, or death. It’s most common in patients who have dementia or other mental conditions that impair judgment or prevent feelings of thirst. Needless to say, soy sauce consumption isn’t a common cause.
Fortunately, the condition can usually be treated easily without any long-lasting effects.
Typically, doctors use intravenous fluids to restore balance to the bloodstream, limiting electrolyte levels and allowing the body to resume normal function. That was difficult in this case—severe self-induced hypernatremia is extremely rare. “We were more aggressive than had been reported before in terms of bringing his sodium back down to a safer range,” Carlberg said. The team at the University of Virginia Medical Center decided to use rapid free-water infusions to quickly rid the patient’s body of the excess sodium. In only 30 minutes, they pumped about 1.5 gallons of a water–sugar solution into the teen’s body. Within about five hours, they were able to restore the patient’s sodium levels to normal. His symptoms didn’t immediately subside, however. The patient remained in a coma for three days, according to doctors, before waking up on his own. He displayed symptoms for an additional several days, likely due to the seizures he’d experienced at the onset of the hypernatremia. Fortunately, these effects were temporary. Doctors told LiveScience that the 19-year-old is back at college and doing well; he doesn’t seem to have any permanent damage from the misadventure. The patient was extremely lucky in this case, as physicians typically treat the rare condition with a slower process. Carlberg’s team elected to use rapid infusions due to the extent of the sodium imbalance, noting the severity of the patient’s condition.
How likely is a soy sauce (or any other type of salt) overdose?
Pretty unlikely. The patient in this case consumed about 0.35 pounds of sodium, an almost impossible amount. In most other cases of self-induced hypernatremia, patients vomit up the excess salt long before the most severe symptoms occur. As the doctors noted in their report, legends claim that ancient Chinese would purposely ingest huge amounts of salt as a way of making atonement, choosing an honorable death as a result of the ensuing hypernatremia. That makes for a great story, but we couldn’t find any definitive sources documenting that practice. Typically, excessive sodium works much more slowly to damage your health. Over time, sodium levels can cause high blood pressure, and they tend to cause calcium loss due to dehydration. There’s also some evidence that sodium negatively affects cognitive function, which certainly makes sense given what we know about extreme hypernatremia. With that said, our bodies need some salt in order to function. Some health experts worry that reducing sodium to extremely low levels may be more dangerous. Low levels of blood sodium—referred to as hyponatremia—can cause many of the same symptoms as hypernatremia, including headaches, confusion, weakness, and fatigue. Typically, hyponatremia occurs when patients have severe gastrointestinal issues, which can cause dehydration. That’s why doctors often recommend electrolyte solutions (for instance, sports drinks) to patients who have diarrhea and vomiting.
The verdict: To stay healthy, it’s important to balance your salt intake.
And don’t partake in any soy sauce dares. The American Heart Association (AHA) recommends a daily sodium intake of no more than 2,300 milligrams. Ideally, adults should limit intake to around 1,500 milligrams per day, although this is also the subject of some controversy. Several studies have demonstrated that diets with higher sodium levels can also be healthy, provided that they’re otherwise balanced. Most soy sauces contain about 879 milligrams per tablespoon-sized serving. A quart of soy sauce contains 56,028 milligrams, which is about 24 times greater than the AHA’s max. Even if the patient had opted for low-sodium soy sauce, he’d have ingested at least 10 times the recommended maximum. And before you start laughing at this teenager’s misfortune, think about the last time you took a stupid dare—and remind yourself that 90 percent of Americans eat too much salt.