A couple notes on the soy sauce colon cleanse video I posted here:
1. I mentioned Jilly Juice briefly in context of how much sodium the patient consumed. J Juice didn't exist, to my knowledge, in 2012 when CG presented. Still, false detox claims aren't new
1. I mentioned Jilly Juice briefly in context of how much sodium the patient consumed. J Juice didn't exist, to my knowledge, in 2012 when CG presented. Still, false detox claims aren't new
2. Stroke in hypernatremia happens, and it's not explained well online. It's a hemorrhagic stroke, meaning it bleeds out into the brain. Another type of stroke is ischemic stroke, where a clot blocks blood vessel in the brain. Hemorrhage happens because of shearing from shrinkage
2. It is discussed in this case report from 2013 of a similar case ncbi.nlm.nih.gov/pubmed/23735849 which brings me to the next point.
3. When the above report of a 19 y/o M happened, many online articles discussed cerebral edema that arises from hypernatremia. It's the miscorrection of the hypernatremia, not the hypernatremia itself that causes the edema. This is due to brain adaptation nejm.org/doi/full/10.10…
4. Central Pontine Myelinolysis (CPM) was first described as such in literature in 1959. Several cases of alcoholics with destroyed myelin sheaths on all parts of nerve fibers in the central pons, with no evidence of inflammation in or near the lesion ncbi.nlm.nih.gov/pubmed/13616772
5. Since this time, there's an Extra Pontine Myelinolysis (EPM) that's been described (outside the pons) and both CPM and EPM are under the term Osmotic Demyelination Syndrome (ODS)
6. Signs and symptoms of ODS are partially reversible or irreversible and include dysarthria, dysphagia, quadriparesis, behavioral disturbances, movement disorders, seizures, lethargy, confusion, disorientation, obtundation, and coma ncbi.nlm.nih.gov/pubmed/8025225
7. In literature, ODS is usually documented in Chronic Hyponatremia that is corrected too quickly. The very first medical video I made about a woman drinking 3 gallons water is Acute Hyponatremia, which can be corrected quickly-- very different.
8. It looks like the same principles from the Adrogué NEJM review in 3) likely apply for Acute Hypernatremia and ODS. In reality, ODS in Acute Hypernatremia is not documented often in literature. But also, it's not often you see sodium levels above 200 like in this case.
9. We still don't fully understand the pathophysiology, but it appears organic osmolyte accumulation in brain adaptation induces DNA fragmentation, cell death -> demyelination. ncbi.nlm.nih.gov/pubmed/1391705 and ncbi.nlm.nih.gov/pubmed/23413245
10. The Celiac disease finding was a little unexpected. Even worse, soy sauce is made of wheat and also has a lot of gluten in it. Her intestinal manifestation of it was the malnutrition, vitamin and iron deficiency. Non-specific and not immediately obvious!
11. I know GI docs can be hesitant to do the testing, scope, biopsy for celiac because 1) it's invasive & 2) expensive. Much easier to try a gluten free diet in patient to see their response. (celiac is minority, don't spread gluten fears, but be aware) nejm.org/doi/full/10.10…
12. Delusional disorder in this patient did somewhat coincide with her demographic in age and female sex. A Spanish registry described 467 patients w/ delusional disorder, 56.5% female & mean age of 55 years. These cases are usually refractory to medicine. ncbi.nlm.nih.gov/pubmed/18082379
13. But psychosis and delusions are also extra intestinal manifestations of... celiac disease ncbi.nlm.nih.gov/pubmed/26260366
14. Going back to 1) on Dr Phil I saw a good explanation of what happens in increased salt intake, but in an extreme case like 120 grams in a gallon (3.79L), many other things happen, just like in this soy sauce colon cleanse case.
I don't go into this level of detail in video (though the citations are listed in the description) because it's for general audience. Students and the clinically trained may be more inclined to read this. What do you think? Thanks! 👨⚕️👩⚕️💊🤗
