Survival after severe hypernatremia due to salt ingestion by an adult

doi:10.1016/0002-9343(85)90483-8

The American Journal of Medicine

Volume 78, Issue 1, January 1985, Pages 176-178

https://doi.org/10.1016/0002-9343(85)90483-8 Get rights and content

Abstract

An 85-year-old woman was brought to the hospital with a serum sodium level of 193 mmol/liter following salt ingestion. She was treated with free water replacement and recovered within 48 hours. She represents the sole survivor of salt Ingestion of this severity in the literature.

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There are more references available in the full text version of this article.

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Citation Excerpt :
Elevated salinity makes water unsuitable for human consumption. Patients exposed to brackish water are at risk for hypernatremia, hypothermia, and waterborne infections.1,2 There is minimal published research to guide therapy, and the ability to conduct controlled research is limited.
Exposure to and consumption of brackish water are associated with an elevated risk of infection, hypernatremia, and hypothermia. Minimal data exist to support the diagnosis and treatment of patients with long-term brackish water exposure. We present a case of a patient who spent 5 to 10 d semisubmerged in the Elizabeth River in coastal Virginia. A 55-y-old male presented via ambulance after 5 to 10 d of being “stuck in the mud.” He was hypernatremic, with a sodium of 176 mEq·L^-1, hypothermic to 34.5°C (94.1°F), and hypotensive at 88/50 mm Hg, with a sodium concentration of 176 mEq·L^-1 and an osmolality of 412 mosm·kg^-1. He developed pneumonia, with respiratory cultures growing Vibrio parahemolyticus, Klebsiella oxytoca, and Shewanella algae. He had pustules, which grew Aeromonas hydrophilia and Aeromonas caviae. A nasogastric tube was placed. Using suction, 500 mL of coarse sand and gravel was removed from his stomach. Antibiotics and intravenous fluids were given. The patient fully recovered after 3 wk and was discharged to rehabilitation. Exposure to brackish water can present a unique set of infectious and metabolic complications. Initial care should include treatment of metabolic derangements, such as hypovolemia, hypernatremia, and hypothermia, and treatment of infections with antibiotics based on knowledge of the most likely causative organisms.
Survival of acute hypernatremia due to massive soy sauce ingestion
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Citation Excerpt :
Patients who become acutely hypernatremic are frequently tachycardic and tachypneic, and often develop seizures (1,2,4,6). Fever, mild leukocytosis, altered mental status, confusion, combativeness, and coma have been described (1,4,6,8). Other neurologic findings include increased muscle tone, involuntary muscle twitches, and hyperactive reflexes with clonus (7).
Intentional massive sodium chloride ingestions are rare occurrences and are often fatal.
There are a variety of treatment recommendations for hypernatremia, ranging from dialysis to varying rates of correction. We report a case of acute severe hypernatremia corrected with rapid free-water infusions that, to our knowledge, has not been previously reported.
A 19-year-old man presented to the Emergency Department in a comatose state with seizure-like activity 2 hours after ingesting a quart of soy sauce. He was administered 6 L of free water over 30 min and survived neurologically intact without clinical sequelae. Corrected for hyperglycemia, the patient's peak serum sodium was 196 mmol/L, which, to our knowledge, is the highest documented level in an adult patient to survive an acute sodium ingestion without neurologic deficits.
Emergency physicians should consider rapidly lowering serum sodium with hypotonic intravenous fluids as a potential management strategy for acute severe hypernatremia secondary to massive salt ingestion.
Commonly used metal and crystalline salts in South African traditional medicine
2013, Journal of Ethnopharmacology
Citation Excerpt :
However in this particular study, it was discovered that a duplicate product sold under same name (ndonya) was shown to be dyed sodium chloride (NaCl) which mimics the unmistakably bright orange crystal of the K2Cr2O7 (Fig. 1). NaCl is undoubtedly less toxic than Cr(VI); however incorrect use of NaCl has led to poisoning in both infants and adults (Addleman et al., 1985, Finberg et al., 1963). Considering such products are habitually sold unlabelled, the confusion between K2Cr2O7 and dyed orange NaCl has the potential for disastrous outcomes and needs urgent addressing.
Traditional medicines in the form of plants, animals and/or minerals are used by millions of South Africans. There is currently no data regarding the commonly used mineral elements thus the potential benefits or hazards of such products remain unclear.
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Six widely available salts were analyzed. Ndonya, as it is colloquially known, refers to two products which look identical to the untrained eye—one is dyed table salt and the other is hexavalent chromium. A further product used medicinally, although not widely available, was identified as iron chromite ore.
The array of substances documented, ranging from benign to carcinogenic, stresses the importance of documenting components used in traditional medicine and confirms the necessity to regulate South Africa traditional medicine. Healthcare workers should be aware of the complexities of using such metal salt.
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Fatal hypernatremia due to drinking a large quantity of shoyu (Japanese soy sauce)
2011, Journal of Forensic and Legal Medicine
We report a case of fatal salt poisoning in a 55-year-old woman who suffered from depression and drank a large quantity of shoyu (Japanese soy sauce). She presented with the highest ever documented serum sodium level of 187 mmol/L. This was associated with symptoms of cerebral damage which developed within hours after drinking the soy sauce. She died as a result of massive pulmonary edema, despite intensive medical treatment. Viewing the results of clinical and postmortem investigations together, her death could clearly be attributed to drinking a large quantity of soy sauce.
Sodium
2006, Small Animal Toxicology

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Survival after severe hypernatremia due to salt ingestion by an adult

Abstract

Am J Med

Case of salt overdosage

Br Med J

Hyperosmolar crisis following infusion of hypertonic sodium chloride for purpose of therapeutic abortion

Am J Med

Fatal ingestion of table salt by an adult

West J Med