Podcast 3: Happy Chinese New Year- Be Careful Out There

Written by Theresa Kim MD

Outline

Presentation and overview of 5 articles and topics

1)     Hunan hand

2)     Thousand year old eggs food scandal

3)     Durian induced hyperkalemia

4)     Soy sauce induced hypernatremia

5)     MSG allergy literature review

Summary of Hunan Hand Case Report

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• A 32 year old graduate student developed severe acute onset pain, flushing, and dizziness when exposing his abraded finger tips (he was moving furniture earlier that day) to chili peppers while cooking
  
• Treatment: topical lidocaine, advised by physician to wear gloves when cooking in the future, and to not dunk his hands in cold water in the future
  

Summary of Thousand Year Old Egg Food Scandal

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• The “thousand year old egg†is a traditional food consumed by the Chinese
  
• Other names: century egg, millennium egg, pidan
  
• History: said to be discovered in Hunan during the Ming Dynasty by a homeowner whose home was under construction.  The eggs were found preserved, sitting in a pool of quick lime.
  
• Duck, quail, or chicken eggs are preserved in ash, clay, quick lime, sulfur
  
• Typical processing/fermentation time is weeks to about 2 months
  
• Controversy: addition of industrial copper sulfate to help speed up the fermentation process
  
• Nationwide inspections now mandated by China to evaluate the controversy further
  

Summary of Durian Induced Hyperkalemia Case Report

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• Durian intro: while durian is known to have a creamy delicious taste, the odor is very potent and compared to eating “vanilla ice cream in an outhouseâ€
  
• Durian has more potassium than a banana: 436mg of K/100g vs. 358mg of K/100g
  
• In normal healthy individuals without renal issues ingestion of durian does not commonly result in hyperkalemia
  
• In this case report , a 48 year old woman. Past medical history: diabetes, end-stage renal disease on hemodialysis presents to the hospital with vomiting, then progression to cardiac arrest after durian ingestion
  
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  • Potassium 9.1, typical torsades de pointes wave EKG findings
    
  • Treatment of hyperkalemia: calcium gluconate
    
  • Conclusion: patients with renal dysfunction should be cautious of how much durian they ingest
    
  
  
  

Summary of Soy Sauce Induced

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• 19 year old male came in comatose after being dared to ingesting a quart of soy sauce 2 hrs prior to arrival
  
• Peak sodium 196
  
• The patient received very aggressive fluid hydration
  
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  • 6L D5W
    
  • Soy sauce is 17-18% NaCl
    
  • A quart of soy sauce has 160-170gm ~ 10tbsp of NaCl
    
  • The only critique of the paper is that the use of very aggressive fluid hydration and lowering of sodium should not be generalized to all cases given the risk of central pontine myelinolysis
    
  • In this case extreme measures and aggressive hydration were appropriate given the acute nature of the ingestion, lack of comorbidities limited hydration, and extremely high peak sodium
    
  
  
  

Summary of MSG Allergy Literature Review

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• MSG (monosodium glutamate) is a food additive produced from protein, beetroot or sugarcane
  
• G protein coupled taste receptors recognize MSG as the savory flavor known as “unamiâ€
  
• First case report of MSG complex or Chinese restaurant syndrome published in 1968
  
• MSG complex is a constellation of symptoms ranging from: burning sensation of back of the neck, forearm, and chest, face pressure or thightness, chest pain, headache, nausea, palpitations, numbness or tingling, weakness, drowsiness
  
• This article reviews the current literature available regarding MSG and the symptom complex, bronchospasm, angioedema, urticaria, and rhinitis
  
• Overall it found that in the literature no strong amount of data exists to support these relationships
  
• Anecdotally, however, at least the MSG complex is thought to be a real phenomena
  

Quizzler Answer from Podcast 1

Q: This famous neurologist died of morphine overdose after being diagnosed with terminal cancer

A: Sigmund Freud

Quizzler 2

Please see the end of the podcast

Submit responses as well as any feedback to toxtrivia@gmail.com

The first correct response wins a $10 itunes gift card

Links to Resources

Hypernatremia due to soy sauce ingestion case report

Hyperkalemia due to durian ingestion case report

MSG allergy literature review

Thousand year old egg scandal

History of the thousand year old egg

Losing your durian virginity

Bibliography

Carlberg, D. J., Borek, H. A., & Syverud, S. A. (2013). Survival of acute hypernatremia due to massive soy sauce ingestion. The Journal of Emergency medicine, 45(2), 228-231. doi: 23735849

Leo, C.L., Leong, W.S., Tieh, C.S., & Liew, C.K. (2011). Durian induced hyperkalemia. The Medical Journal of Malaysia, 66(1), 66-67. doi: 23765149

Song, S. (2013). Latest chinese food scandal: Preserved eggs processed with toxic chemical. International Business Times, Retrieved from http://www.ibtimes.com/latest-chinese-food-scandal-preserved-eggs-processed-toxic-chemical-1308855

Weinberg, R.B. (1981). Hunan hand. The New England Journal of Medicine, 305(17), 1020. doi: 7278919

Williams, A. N., & Woessner, K. M. (2009). Monosodium glutamate ‘allergy’: Menace or myth?. Clinical & Experimental Allergy, 39(5), 640-646. doi: 19389112