"Everyone thinks I look like Jackie Chan," says my 52-yr-old patient who was admitted for dilantin toxicity. Only he makes it infinitely more amusing by swooping into a karate chop gesture every time he says "Jackie Chan". Which is quite frequent.
This delightful patient has a seizure disorder for which he takes dilantin and valproic acid. He has a special mantra to remind himself how many tablets of valproic acid to take: "Five in the morning, six at night, no whiskey". I suspect he accidentally used the valproic acid mantra with his dilantin tablets and ended up with a supratherapeutic serum dilantin level.
Our Jackie Chan lookalike also has an oddly low serum sodium level which dipped down to 123 without any apparent neurological symptoms. I was able to get his serum sodium to climb up to 128 (still low) with a bit of intravenous 0.9% saline. With a urine sodium >40 and a slightly low serum osmolality, he probably has SIADH, which is often treated with free water restriction and oral salt tablets. It's the antithesis of what we usually tell our patients: Drink less fluid! Use at least a 1/2 teaspoon of salt with all your meals! The hospital is on a "healthy eating" kick and has substituted all salt packets with Mrs Dash's Salt Substitute. I had to rummage through 3 different staff break rooms before I finally unearthed a plastic container brimming with contraband salt packets. After I sprinkled his scrambled egg breakfast with one of the salt packets, my patient grinned and said, "My brother looks like Mr Miyagi."
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