Recognition and Management of Pediatric Salt Toxicity

Pediatr Emerg Care. 2018 Nov;34(11):820-824. doi: 10.1097/PEC.0000000000001340.

Abstract

Objectives: Immediate recognition of salt toxicity and aggressive resuscitative measures are critical in the treatment of this lethal poisoning. Despite heroic measures, pediatric deaths due to salt toxicity still occur from irreversible neurological damage. The objective of this article is to review the relevant literature and offer a therapeutic algorithm for the management of pediatric patients presenting with salt toxicity.

Methods: A literature search for cases of salt toxicity was conducted. Articles in English that were available electronically through PubMed and Google Scholar were reviewed.

Results: Nineteen cases and case series of salt toxicity were located using our search strategy. Salt poisoning has a distinct pathophysiology compared with hypernatremia, most notable for the lack of formation of idiogenic osmoles.

Conclusions: The approach to treatment differs between salt toxicity and hypernatremia, focusing on rapid correction of serum osmolality rather than gradual normalization of serum sodium concentrations. Consultation of nephrology and child protection services are strongly recommended in the comprehensive treatment approach.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Hypernatremia / etiology
  • Hypernatremia / physiopathology
  • Hypernatremia / therapy*
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Sodium / blood*
  • Sodium Chloride, Dietary / poisoning*
  • Young Adult

Substances

  • Sodium Chloride, Dietary
  • Sodium