A case of cardiopulmonary arrest due to bittern overdose-induced hypermagnesemia and hypercalcemia that was successfully treated with multimodal management

Abstract

Bittern is made by extracting the salt from marine water, and it contains various amounts of electrolyte components, such as magnesium and calcium. The excess consumption of bittern can therefore lead to electrolyte imbalances. We report a case in which a bittern overdose induced hypermagnesemia and hypercalcemia complicated by cardiopulmonary arrest. A 21-year-old Japanese female was transported to our emergency room approximately 8 hours after ingesting a bottle of bittern. On arrival, she could speak, but cardiopulmonary arrest suddenly occurred. Her initial blood chemistry showed hypermagnesemia and hypercalcemia. We immediately initiated hemodialysis. The serum concentrations of magnesium and calcium gradually decreased after the initiation of hemodialysis, and they had normalized by hospital day 3. Electrolyte monitoring and the early initiation of hemodialysis are useful for treating a bittern overdose. As hypermagnesemia can induce not only cardiopulmonary arrest, but also a systemic hemorrhage tendency, multimodal management is very important.