SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: The current South Korean beauty trend includes achieving excessively thin body habitus. Myriads of reviews are being posted on popular sites, such as Instagram and YouTube, that promote a type of diet plan involving a course of large volume water intake (Figure 1). With the potential for widespread adoption of this diet fad, the incidence of life-threatening hyponatremia will likely increase among young healthy adults. Here we describe a case of life-threatening hyponatremia induced by a calorie restricting diet centered around large volume free water intake. CASE PRESENTATION: A 27-year-old Korean female had an episode of witnessed generalized tonic-clonic seizure for 15 minutes after multiple episodes of non-bloody vomiting and diarrhea. There was no associated aura, but she had eye rolling and foaming at mouth followed by postictal unconsciousness. She had no previous history of seizures, nor was she on any psychotropic medications. The patient was on a strict diet regime that involved drinking 4 to 5L of free water, while simultaneously restricting salt in her diet. She was brought to the emergency department (ED) and was emergently intubated for airway protection. Computed tomography of the head was normal. Initial serum sodium was 115 mmol/L, with a serum osmolality of 244 mOsm/kg, and urine osmolality 304 mOsm/kg. She was given 2L of normal saline in the ED and the sodium rapidly corrected to 133 mmol/L. The rapid correction was arrested with intravenous free water and concurrent use of desmopressin. She regained her baseline mental status without further seizure episodes. DISCUSSION: A famous Korean pop (Kpop) star shared her secret diet regime during an interview. She described 5-day course of large volume free water intake throughout the day that increases the urine output and provides satiety that also helps her with low-calorie diet [1]. This “Skeleton-skinny diet regime” has become a phenomenon in South Korea through so-called “social media influencers” who would recommend this diet regime without noting its potential health hazards. The clinical presentation of primary polydipsia commonly involves a clear history of mental illness and/or psychotropic medications. Polydipsic behavior has been described in up to 18% of schizophrenic patients [2]. Our patient did not have a history of mental illness, and was not on any antidepressants. This is the first case to describe a life-threatening hypo-osmolar state from intentional water intoxication. CONCLUSIONS: This case highlights the need for not only primary care physicians but also critical care physicians to be cognisant of the cultural beliefs and norms of different patient populations. With the continued globalization of healthcare, early recognition of this culturally sensitive etiology is of great importance in starting prompt treatment of this life-threatening diagnosis in the critical care setting. Reference #1: Kim, A. (2017, November 16) IU Reveals Her "Skeleton-skinny Diet Regime” Retrieved from: https://mnews.joins.com/article/22121703?IgnoreUserAgent=y#home Reference #2: Bhatia MS, Goyal A, Saha R, Doval N. Psychogenic Polydipsia - Management Challenges. Shanghai Arch Psychiatry. 2017;29(3):180-183. DISCLOSURES: Advisory Committee Member relationship with Ambu Please note: $1-$1000 Added 03/29/2019 by Olumayowa Abe, source=Web Response, value=Honoraria no disclosure on file for Christian Castaneda; No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Joon Ha Woo, source=Web Response