Moder K G, Hurley D L
Department of Internal Medicine, Division of Endocrinology/Metabolism, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1990 Dec;65(12):1587-94. doi: 10.1016/s0025-6196(12)62194-6.
Hypernatremia is a common electrolyte disturbance, most often caused by volume depletion. Hypernatremia due to sodium excess occurs less frequently, and fatal hypernatremia solely from ingestion of table salt is rare. We describe a 41-year-old man who had seizures and hypernatremia after ingestion of a supersaturated salt water solution intended for gargling. He had consumed approximately a third cup of table salt (approximately 70 to 90 g of salt or 1,200 to 1,500 meq of sodium). His initial serum sodium concentration was 209 meq/liter. Hypotonic fluid therapy was given to provide free water and to correct the hypernatremia gradually. Our patient, however, failed to recover from the initial insult and died 3 days later. Review of the literature revealed 10 adult and 20 pediatric cases of hypernatremia attributable to exogenous intake of salt. The type of therapy (fluid or peritoneal dialysis), the type of fluid used, and the rate of correction of hypernatremia did not influence survival. The age of the patient and the initial serum sodium concentration were the most important prognostic indicators. Both very young patients and those with lesser degrees of hypernatremia had a better rate of survival than did other patients. In addition, our review illustrates the surprisingly small amount of salt that can cause severe hypernatremia and the danger of using salt or saline as an emetic.
高钠血症是一种常见的电解质紊乱，最常见的原因是容量不足。因钠摄入过多导致的高钠血症较少见，仅因摄入食盐而导致的致命性高钠血症则很罕见。我们描述了一名41岁男性，他在摄入用于漱口的过饱和盐水溶液后出现癫痫发作和高钠血症。他摄入了约三分之一杯食盐（约70至90克盐或1200至1500毫当量钠）。他最初的血清钠浓度为209毫当量/升。给予低渗液体疗法以补充自由水并逐渐纠正高钠血症。然而，我们的患者未能从最初的损伤中恢复，3天后死亡。文献回顾显示有10例成人和20例儿童因外源性摄入盐分导致高钠血症的病例。治疗类型（液体或腹膜透析）、所用液体类型以及高钠血症的纠正速度均不影响生存率。患者年龄和初始血清钠浓度是最重要的预后指标。非常年轻的患者和高钠血症程度较轻的患者的生存率均高于其他患者。此外，我们的回顾表明，导致严重高钠血症所需的盐量惊人地少，以及使用盐或盐水作为催吐剂的危险性。
