The Unreal World: 'Miami Medical' accident injuries and surgeries a stretch?

The Los Angeles Times—July 12, 2010

Dr. Dale Lange, neurologist-in-chief at HSS, answers questions about a popular medical show, Miami Medical, in the LA Times' "Unreal World," a segment which explores the reality behind medical scenarios on television.

The premise: A school bus crash in the Florida Everglades hurls teacher Lori Wilson (Elizabeth Ho) into a canal and damages the spine and brain of 16-year-old Ben Sims (John Bain). They're both brought to the trauma center at Miami Medical for treatment. When Lori's hands swell and she develops a sudden inability to find words (dysphasia), Dr. Chris Deleo (Mike Vogel) struggles to figure out what's wrong with her. An MRI of the brain is normal. He finally discovers that she has a very low sodium level (hyponatremia) from swallowing too much water in the canal and, when he treats her with hypertonic (3%) intravenous sodium chloride, she improves.

The medical questions: Can swallowing canal water lead to a low level of sodium in the blood, swollen hands and difficulty finding words? Would this be a difficult diagnosis to make and would the treatment be a 3% sodium solution?

The reality: Drinking a large quantity of pond water could dilute the blood and lead to hyponatremia, says Dr. Dale Lange, neurologist-in-chief at the Hospital for Special Surgery in New York. And fluid-swollen, or edematous, hands could result ó as could dysphasia (difficulty communicating or comprehending) because of swelling in the brain, Lange says. But the condition would much more likely be associated with tap or bottled water; canal water is not typically as hypotonic. And a very low blood-sodium level is much easier to diagnose than the show suggests. The sodium level would be part of routine tests for accident victims.

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