The differential diagnosis of hypernatraemia in children, with ...

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
4.6 Additional causes of hypernatraemia in adults
Clinical question
What additional agents and mechanisms causing hypernatraemia are described in adults?
There are a number of reported cases of deliberate self-harm in adults involving the taking
of sodium. These include 2 reports of Soy sauce ingestion 254, 255 two of sodium hypochlorite
(bleach), 256, 257 and one of salt. 258 One patient took an overdose of colchicine and induced
a temporary diabetes insipidus. 259
Three adults mistakenly took excessive amounts of salt. Two died as a result. Two had
learning difficulties (one aged 41 with Down syndrome 226, 260 and a second aged 45 with
Prader-Willi syndrome 261 ); the third, aged 85, had dementia. 223
A 26 year old with learning difficulties died after ingesting flavour intensifier containing
sodium chloride and sodium glutamate, apparently in error. His peak sodium was 176
mmol/L. 262
A 35-year-old fisherman was rescued after spending 11 hours in sea water in a hurricane.
He had inadvertently swallowed sea water (with a sodium concentration of between 300
and 500 mmol/L). His initial sodium was 175 mmol/L. 228 He made a full recovery.
There are three case reports of hypernatraemia following exorcism rituals. 227, 263, 264 In each,
as part of the ritual, the subject was required to drink large volumes of salt water. Sodium
concentrations of 246, 255 and 153 mmol/L were recorded in women aged 36, 20 and
19 years respectively. All three women died (the third woman was said to have died of
asphyxia, having been beaten as well).
A 53-year-old man developed hypernatraemia with a sodium of 168 mmol/L 12 days after
his ischio-rectal abscess started being irrigated twice daily with Milton as a substitute
for Eusol. The Milton contained 780 mmol/L of sodium, and his 24-hour urinary sodium
excretion rose to a maximum of over 300 mmol/24 hrs. 265
There are reports of adults developing hypernatraemia whilst on hyperosmolar feeds.
The first 266 , in a 59-year-old woman with psychosis who had refused to eat for 8 days,
had a sodium of 164 mmol/L after one week of hyperosmolar feeds administered via a
nasogastric tube. There was evidence of dehydration. The other reports from the 1950s and
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