Bizarre case of hypernatremia: a suicide attempt by a 73 year-old Japanese man in which the individual drank massive amounts of soy sauce. According to this 2006 Neurology paper by Machino et al, the patient presented with vomiting, tremor, and altered mental status, along with a serum Na of 188 mEq/L, a serum chloride of 142 mEq/L, and a serum osmolarity of 314 mOsm/kg. MRI imaging demonstrated symmetric brain shrinkage consistent with severe, acute hyperosmolarity. Fortunately, rapid correction of the patient’s sodium (the soy sauce ingestion had apparently been within 12 hours of his initial presentation) led to rapid clinical improvement. A similar 2004 case report by Sakai et al suggests that acute hemodialysis is another way to rapidly reverse hypernatremia as caused by acute soy sauce ingestion (over 1 Liter in this paper!).