Recognition and Management of Pediatric Salt Toxicity

Abstract

The approach to treatment differs between salt toxicity and hypernatremia, focusing on rapid correction of serum osmolality rather than gradual normalization of serum sodium concentrations. Consultation of nephrology and child protection services are strongly recommended in the comprehensive treatment approach.

Salt Toxicity: A Systematic Review and Case Reports

“…Salt toxicity is a rare form of hypernatremia that typically occurs after a single massive exposure to salt (sodium chloride) over a short period of time, such as minutes to hours. [5][6][7] The information regarding salt toxicity is gathered largely from anecdotal case reports. For this reason, it is difficult to determine the specific levels of salt intake capable of causing salt toxicity.…”

“…In children, mortality in salt toxicity is especially high when the plasma sodium level exceeds 190 mEq/L. 5,9 In a report of 2 adults who died from salt toxicity, the plasma sodium levels were 175 mEq/L and 196 mEq/L, respectively. 10…”

“…A massive ingestion of salt causes the plasma sodium concentration to elevate within minutes and peak within hours. 5,11 As a result, the cells shrink because fluid is drawn osmotically from the intracellular spaces; this process is particularly dangerous in brain cells. Irreversible neurological injury can result; intracranial hemorrhages are found commonly during the autopsy of salt toxicity victims and are believed to result from shearing forces in the brain due to osmotic fluid shifts.…”

“…6,14 Brain volume is largely restored within a period of 2 to 3 days. 15 Although brain injury in salt toxicity is attributed generally to osmotic fluid shifts, Blohm et al 5 point out that cerebral edema may develop in response to diffuse cellular injury, as evidenced in case reports in which cerebral edema occurred in patients before treatment.…”

“…For example, salt toxicity typically involves an event in which a recent massive salt consumption occurred, whereas 16 hypernatremia from fluid loss is usually preceded by several days of fluid loss (as in diarrhea, vomiting, or sweating). 5 The gastrointestinal symptoms associated with a large oral intake of salt include nausea, vomiting, abdominal cramps, and diarrhea, presumably due to the mucosal irritation and fluid shifts associated with the hypertonic solution. These symptoms need to be evaluated in conjunction with other findings because they may cause clinicians to erroneously believe that the fluid loss is the cause for hypernatremia.…”