2021 Volume 33 Issue 2 Pages 187-191
Salt poisoning is a rare but potentially fatal occurrence. In adults, it generally occurs as a result of attempted suicide by salt ingestion in the context of mental illness. Features of severe brain insult, such as intracranial hemorrhage and cerebral edema, can be observed at autopsy and are often presumed to be the cause of death. However, the clinical course remains unclear in many aspects. We report here a case of a woman in her early 40s who was being treated for depression and membranous nephropathy with antidepressants and prednisolone. She ingested 200 g salt in a suicide attempt and was emergently transferred to hospital. On arrival, she was drowsy and laboratory results revealed hypernatremia (155 mmol/L). Hypotonic fluid replacement was started. The next day her level of consciousness improved and the hypernatremia resolved. On hospital day 6, she suddenly developed subarachnoid hemorrhage due to ruptured dissecting aneurysm of the right vertebral artery. Emergent coil embolization was performed. She eventually recovered but with minor neurological sequelae. Hypernatremia from salt poisoning causes brain cell shrinkage and is thought to cause cerebrovascular rupture via wall shear stress. However, our patient developed subarachnoid hemorrhage even after hypernatremia had resolved. Little is known about the clinical course of salt poisoning, and therefore even after consciousness has improved and hypernatremia has resolved, the risk of physical catastrophe should rightly be overestimated and special attention to management is needed to forestall further physical complications.
