The management of extreme hypernatraemia secondary to salt poisoning in an infant

Abstract

We describe a five-week-old boy who had seizures and extreme hypernatraemia secondary to ingesting an improper home-made formula. Initial sodium concentration was 211 mmol.l-1. Other clinical and biological features were moderate dehydration and renal insufficiency with generous urine output and high urinary sodium concentration. Fluid therapy with hypotonic dextrose solution corrected the volume deficit in 48 h and progressively decreased the serum sodium concentration. During ICU stay the patient developed recurrent episodes of seizures and pulmonary oedema requiring mechanical ventilation for five days. Recovery was complete with no abnormal sequelae after a ten-month follow-up. Salt poisoning is in unusual cause of extreme hypernatraemia. It can be safely managed with fluid therapy alone if urine output is preserved, with progressive decrease of serum sodium as target. If this condition is recognized, outcome should be favourable.

The epidemiology of hypernatraemia in hospitalised children in Lothian: a 10-year study showing differences between dehydration, osmoregulatory dysfunction and salt poisoning

“…All reported cases of salt poisoning, including ours, have been associated with high sodium concentrations in urine (if collected), exceeding those in plasma 18 28–31. Only if urine sodium exceeds plasma sodium concentration in a hypernatraemic child before treatment should this be taken as evidence of salt poisoning.…”

Severe Hypernatremia by Excessive Bamboo Salt Ingestion in Healthy Young Woman

“…Paut et al report a survivor from extreme hypernatremia in accidental salt poisoning in an infant13). Ofran et al described highest sodium plasma level of 255mEq/L in a female with psychiatric disorder7).…”

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

“…Severe hypernatremia (defined as a serum sodium concentration > 160 mmol/L)3 has been described in various case reports, as high as a serum Na concentration of 196 mmol/L, 201 mmol/L, 202 mmol/L, or 211 mmol/L 3,5,18,19. In addition, in a reported case of fatal ingestion of sodium hypochlorite bleach, the patient showed hypernatremia (serum Na, 169 mmol/L) and hyperchloremia (Cl, 143 mmol/L) in association with metabolic acidosis,20 and a patient with acute salt poisoning, due to an overdose of sodium chloride, showed a Na load of 400 mmol/L over 12 hours 21.…”