Heather A. Borek

Survival of Acute Hypernatremia Due to Massive Soy Sauce Ingestion

BACKGROUND Intentional massive sodium chloride ingestions are rare occurrences and are often fatal. OBJECTIVES There are a variety of treatment recommendations for hypernatremia, ranging from dialysis to varying rates of correction. We report a case of acute severe hypernatremia corrected with rapid free-water infusions that, to our knowledge, has not been previously reported. CASE REPORT A 19-year-old man presented to the Emergency Department in a comatose state with seizure-like activity 2 hours after ingesting a quart of soy sauce. He was administered 6 L of free water over 30 min and survived neurologically intact without clinical sequelae. Corrected for hyperglycemia, the patients 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. CONCLUSION Emergency physicians should consider rapidly lowering serum sodium with hypotonic intravenous fluids as a potential management strategy for acute severe hypernatremia secondary to massive salt ingestion.

Electrical Therapies in Cardiac Arrest

Recognition and appropriate treatment of ventricular fibrillation or pulseless ventricular tachycardia is an essential skill for healthcare providers. Appropriate defibrillation can improve survival and benefit patient outcome. Similarly, increased public access to automatic electronic defibrillators has been shown to improve out-of-hospital survival for cardiac arrest. When combined with high-quality cardiopulmonary resuscitation, electrical therapies are an important aspect of resuscitation in the patient with cardiac arrest. This article focuses on the use of electrical therapies, including defibrillation, cardiac pacing, and automated external defibrillators, in cardiac arrest.

How not to train your dragon: a case of a komodo dragon bite

Komodo dragons (Varanus komodoensis) are the worlds largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. Reports in the medical literature are lacking. We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management.

A Case of Cyanide Poisoning and the Use of Arterial Blood Gas Analysis to Direct Therapy

Abstract Cyanide poisoning is a difficult diagnosis for health care professionals. Existing reports clearly demonstrate that the initial diagnosis is often missed in surreptitious cases. The signs and symptoms can mimic numerous other disease processes. We report a case in which a suicidal patient ingested cyanide and was found unresponsive by 2 laboratory coworkers. The coworkers employed cardiopulmonary resuscitation with mouth-to-mouth resuscitation. The suicidal patient died shortly after arrival to the hospital, while the 2 coworkers who performed mouth-to-mouth resuscitation presented with signs and symptoms that mimicked early cyanide toxicity but were instead due to acute stress response. An arterial blood gas analysis may help aid in the diagnosis of cyanide toxicity. Electrocardiographic findings in a patient with cyanide poisoning range significantly, depending on the stage of the poisoning.

In reply to Drs Weinstein and White

We thank Drs Weinstein and White for their interest in the article, “How not to train your dragon: a case of a Komodo dragon bite,” and your thoughtful comments. We recognize that the use of the term venomous is controversial when referring to Komodo dragons (Varanus komodoensis). The aim of this article was to present a case report and give a brief review of the literature, including the theories involved in mortality after a Komodo dragon bite, which include trauma, sepsis, and a venom deposition theory. We note that despite the theory that envenoming may occur, no signs of envenoming occurred in our patient; despite the theory that wound infection and sepsis may occur, amoxicillin-clavulanate appeared to mitigate any potential infection in our case. Our patient did experience morbidity as a result of a direct traumatic injury from the bite. Language: en