Can too little be as bad as too much?

By Madhava Sai Sivapuram

Any substance which is taken too much or too little is poisonous to our body whether it is a drug or a diet”. These were the exact words told by my pharmacology professor when I was studying pharmacology. I thought yes, if there is excessive use of drugs, it is going to cause adverse drug reactions, whereas too little may not help us recover. With regards to the human diet, too much can cause obesity which is a risk for many diseases, whereas too little will make you undernourished. I never thought that a person’s diet could be a cause of a life-threatening situation.

I faced such a situation during my BMJ Case Reports elective period[1] It was a completely new environment for me where hospital experiences a very good outpatient and inpatient flow. It was the 3rd or 4th day of my electives where I was still trying to understand the workflow of the hospital. I came across a middle-aged lady waiting outside the ward for my professor, as he was the attending physician of her father, who was admitted due to sudden fall on the ground, following a decrease in blood pressure. He had been taking medication for diabetes and hypertension for the past 10 years.

My professor had asked me to take the patient history and find out the reason for the fall in the blood pressure, but I could not do that as the patient was discharged on the same day.

It was a 3-week elective and I enjoyed working alongside my professor, who always gave me a new prospect to think about. Two days before my departure from the hospital, I got a chance to meet the patient and the family again; they had come in for a follow-up. This time the patient load in the OPD was not as high. My professor spends a lot of time with patients discussing their history and always tells me the cause of the problem is always in the patient’s history. If we could figure this out, we would solve the puzzle, which is the beauty of medicine.

The lady told us that her father was having a problem with his blood pressure and during her recent visit to the family doctor, she was told that he should reduce his salt intake. She misunderstood the instruction to be that he should eat no salt at all, and she started cooking dishes exclusively for him without salt in them and was taking extra care that he was not eating any food that contained salt.

From this, we learned that her misunderstanding had cost them a lot of money and precious time. We explained to them what had gone wrong with the patient and suggested they increase his salt intake to a certain threshold.

This BMJ Case Reports elective experience has led me to remember my pharmacology professor’s words practically in a real-life scenario. It also made me understand how important it is to fully inform the patient and their attendants, and also the necessity of checking their understanding.  Any misunderstanding with our health education comes at a huge price for the patients and their attendants.

I acknowledge Professor Rakesh Biswas under whom I did this elective.



Competing Interests

None Declared