Electrolytes external Flashcards
Can vitreous electrolytes identify exogenous poisoning
Yes
ADME of sodium chloride
rapid absorbed and distributed before significant elimination
Pediatrics and adults sodium chloride
Pediatrics
Immature kidneys decreased ability to excrete excess sodium
Adults
Nine gms of salt [approx. 2 teaspoons] increase serum conc by 10 mEq/L
Hypernatermia electrolytes external
Excess sodium will cause a hyperosmolar effect
Water moves from intracellular space to extracellular spaces
Intracellular dehydration
Vascular overload
Brain shrinkage
Tearing of cerebral vascular
Cerebral hemorrhage
Death may occur within a few hours
Hypernatremia-induced hemorrhage
Mortality rate 40 – 70%
Salt poisoning
Accidental salt poisoning is rare but has been reported in children and adults
Ingestion of supersaturated salt soln meant for gargling has led to the death
Hypernatremia due to “salting” of an infant’s skin during the early neonatal period may be fatal
Old customs in Turkish communities originated in Middle Asia
Topical administration of sodium salts on burned or injured skin has resulted in hypernatremia leading to death
sodium tox case study Pica
Six yr boy presented to hospital following seizure
Na: 234 mEq/L and Cl:205 eq
Different dx R/o: Diabetes insipidus, dehydration, renal pathology, other 1 cause
Hx of pica
Search of home revealed rock salt and container of table salt
Est. ingestion 4 tbs
drug ingestion electrolyte treatment
Emetics or gastric lavage
Tx with hypertonic salt solutions as emetic
May result in fatal hypernatremia
Na+ > 200 mEq/L
salt water as emetic case study
14-year-old boy returned home from a party told his parents he took some “pills” [maybe Ritalin/Darvocet]
Given salt water to induce emesis
Est approx. 45 g [5 tbsp] absorbed
Vomited several times, then collapsed
EMS called had two clonic/tonic seizures in route
Dx with hypernatremia [195 mmol/L]
Chloride 160 mmol/L Glu: 221 mg/dL
UDS: negative
Despite Tx – Died
exorcism case study
20-year-old female with postpartum depression
Fluoxetine Tx
Family convinced pt to participate in a local ceremony of “exercism”
Pt drank six glasses of salt water [1 kg/L]
11 hours later – pt lethargic, developed generalized seizures
Serum Na: 255 mmol/L
Aggressive medical intervention
Hypotonic fluid resuscitation
Died a few hours post arrival
Soy sauce cases
Case 1
19 year old male
Comatose with seizure-like activity
Post 2 hours ingestion of 1 quart of soy sauce
Tx: 6 liters of water over 30 minutes
Labs
Hyperglycemia and hypernatremia [196 mmol/L]
Survived neurologically intact without clinical sequalae
Case 2
60 year old female suicide
Empoty 1000 mL bottle of soy sauce purchased day before
Found dead in bed
Est dose of 160 g of salt
Case 3
55 year olf female
Hx of depression
Consumed large quantity of soy sauce
Neurological symptoms within hours
Sodium 187 mmol/L
Evan Brewer case
3-year-old boy was found encased in concrete
Autopsy couldn’t determine the cause and manner of Evan’s death
Body was decomposed by the time he was chipped out of the block of concrete
Toxicology positive for Benadryl [non-toxic concentration]
Testimony from mother she thinks Bodine sickened him in the days leading up to his death by force-feeding him large amounts of salt
non-accidental salt poisoning
Salt poisoning is part of Munchausen syndrome by proxy child abuse
Adding salt to drink or directly placing in the mouth
Serum Na+ concentrations may exceed 200 mEq/L
Immature kidneys unable to excrete excess Na+
Mommy blogger
Lacey Spears craved attention received through her 5-year-old boy
Detained her son’s mysterious illness for years on her blog “Garnett’s Journey”
Also took to social media shared updates on her son’s condition, writing about his health struggle up until his death
Huge following online
He passed away on Jan 23, 2014
Intentionally force-fed salt via feeding tube
March 2, 2015, found guilty of murder
20 years to life
Baugh et al case
Baugh et (1983) report a case of salt poisoning as a result of punishment for enuresis
5-year-old boy presents due to three hours of diarrhea and facial pallor
Had been well until 12 hours earlier when “loose” stools began, which worsened rapidly, with profuse watery diarrhea, urinary incontinence, pallor, and lethargy
Eyes sunken, oral mucosa moist, but lips were dry
Presumptive Dx was dehydration – tx with normal saline [15 mL/kg] promptly producing 200 mL of urine
Serum Na+ 184 mEq/L and Cl- 143 mEq/L
With abrupt decline in serum Na+ neurological status improved, lethargy disappeared and resulting of cardiac dysrhythmias resolved
Pt reluctantly admitted parents had given him salt
Water intoxivation and symptoms
Rare condition originates from over consumption of water
Initial symptoms
Increased water intake [polydipsia]
Urination of large volumes of dilute urine [polyuria]
Other symptoms
Headache, nausea, and vomiting
Behavioral changes
Muscle weakness, twitching, and cramping
Sensory disorders, confusion, irritability, and drowsiness
May be fatal
