Poisoning with table salt while treating drug poisoning

• Published in: Journal of forensic sciences 2024-11, Vol.69 (6), p.2325-2330
• Main Authors: Smędra, Anna, Wochna, Katarzyna, Gruchała, Jacek, Berent, Jarosław
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents; Blood pressure; clinical toxicology; Disorders; emetics; forensic pathology; Humans; Hypernatremia; Hypernatremia - chemically induced; Hypernatremia - etiology; Information retrieval; Male; Malpractice; Medical malpractice; Medication Errors; Middle Aged; NaCl poisoning; Paramedics; Poisoning; prehospital care; Reflexes; Saline solutions; Signs and symptoms; Sodium; Sodium Chloride; Vomiting; Vomiting - chemically induced
• ISSN: 0022-1198; 1556-4029; 1556-4029
• DOI: 10.1111/1556-4029.15623

Hypernatremia is an increase in serum sodium concentration above 145 mmol/L. There are many causes of elevated sodium levels in the blood serum. One is incorrect actions performed by medical staff. The symptoms of excessively high serum sodium levels depend on the severity of hypernatremia, the rate of its increase and the accompanying volume disorders. Severe symptoms include altered consciousness, increased muscle tone and reflexes, convulsions, psychomotor hyperactivity or drowsiness (up to coma), respiratory failure, and even death. We present the case of a 45‐year‐old man who took seven tablets of a blood pressure‐lowering drug, and paramedics subsequently administered a concentrated solution of table salt to induce vomiting. However, vomiting did not occur, leading to hypernatremia. Ultimately, the man survived but developed persistent cognitive dysfunction, including disordered short‐term memory and encoding and retrieval of information from long‐term memory, weakening of attention function and fatigue, and disorders in thinking. The patient's family went to the prosecutor's office to investigate the possibility of medical malpractice. Experts found that the paramedics' actions were incorrect. Although it has been known for many years that table salt solutions should not be used to induce vomiting, unfortunately, both laypeople and medical professionals are still using this technique. Iatrogenic salt poisoning may end not only in serious health complications but also in legal consequences.