hypernatremai salt drowning

1. Salt Intoxication
DR DARYOOSH FAHIMI

2. Case History
 A 4-yr old boy drowned in seawater, rescued and resuscitated by
lifeguards and then transferred to the nearest Emergency
Department. Upon arrival to ED, the airways, breathing, and an IV
line were secured and blood samples were drown.
Patient then transferred to PICU.
Results of lab tests were as followed:
Na= 180 mEq/L
K= 4 mEq/L
Ca= 8 mg/dl
BS= 300 mg/dl
How do you manage the patient’s fluids and electrolytes?

3. Etiology of Hypernatremia
 1- Salt intoxication
Sea water drowning
Multiple infusions of hypertonic saline or sodium bicarbonate
Intentional salt poisoning
Improperly made milk formula
 2- Pure water deficit
 3- Combined water and sodium deficit
 4- Essential hypernatremia
 5- Drug induced pseudohypernatremia

4. Clinical Manifestations
 Irritability, restlessness, excessive thirst, fever, hyperpnea, high-
pitched cry, hyperglycemia, hypocalcemia
 Neurologic symptoms and signs
Brain hemorrhage, Central pontine or extrapontine myelinolysis
 Respiratory symptoms and signs
Obstruction of airways by aspirated materials, washout of surfactant and
atelectasis
 Seawater Vs freshwater drowning
“Clinical management is not significantly different in saltwater and freshwater
aspirations, because most victims do not aspirate enough fluid volume to make a
clinical difference”
 Signs of circulatory overload especially during treatment

5. Salt Intoxication
 It should be differentiated from hypernatremic dehydration
weight FENa BUN, Cr Nausea &
vomiting
Diarrhea Gastric Na
concentration
Salt intoxication N or ↑ >2% ↓ + + ↑
Hypernatremic
dehydration
↓ <1% Prerenal
azotemia
+ + Not changed

6. Salt Intoxication Vs Hypernatremic
Dehydration
 Serum Bicarbonate
 Serum K
 Calculating free water deficit and comparing it to observed weight
loss
Water deficit = Current body water × (
𝑃𝑙𝑎𝑠𝑚𝑎 𝑁𝑎
140
– 1)

7. Differences of Salt intoxication With
Other Types of Hypernatremias
 Idiogenic osmoles need 24-48 hrs to fully accumulate in brain cells
 Rapid correction of hypernatremia without fear of cerebral edema
 Infusion of hypotonic fluids even DW5% (without electrolytes)
 Higher probability of circulatory overload during treatment
 Use of furosemide for prevention and treatment of overload

8. Treatment of Salt Intoxication
 Rapid correction of hypernatremia if it has been developed less
than 24- 48hr
 Hypotonic fluids e.g DW5% + furosemide (1mg/kg/dose)
 Dialysis or CRRT (Na > 180)