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Abstract

A 52-year-old unemployed Japanese woman with depression was brought to our emergency department (ED) after an attempted suicide. She had reportedly ingested 1500 mL of soy sauce (corresponding to 277.5 g sodium chloride) 60 min before presentation. She was taking prescribed mirtazapine, 15 mg daily. In the ED, she was agitated, and a physical examination revealed a Glasgow Coma Scale (GCS) score of 14 (E4V4M6), a respiratory rate of 20 breaths/min, an oxygen saturation of 100% on room air, a blood pressure of 115/94 mmHg, a pulse rate of 110/min, and a temperature of 35.6℃. As her initial blood [Na] was 171 mEq/L (serum [Na] was 173mEq/L), 5% dextrose solution (D5W) was intravenously administered. At 30 min post-arrival, a second blood analysis revealed an increase in her blood [Na] to 179 mEq/L and her consciousness level dropped to a GCS score of 7 (E1V2M4) with a convulsive seizure. A plain computed tomography (CT) of the head revealed bilateral cerebellar hemorrhage. An intravenous bolus administration of D5W lowered her blood [Na] from 179 to 162 mEq/L over a period of 40 min, which improved her consciousness. After this rapid correction, her blood [Na] was lowered at a rate of 0.55 mEq/L per hour. Although magnetic resonance imaging (MRI) of the head, performed on day 7, revealed hydrocephalus and cerebellar edema, she was asymptomatic. She was discharged on day 57 without neurological sequelae.

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