Fatal Poisoning by Exogenic Intake of Sodium Chloride

The aim of this study is to point to the dangers of hypernatremia by exogenic intake of sodium chloride through ingesting excessive amounts of common salt or through aggressive correction of electrolytic disorders by using hypertonic solutions of sodium chloride, which may lead to heavy intoxication followed by metabolic encephalopathy (ME) and, very often, to a fatal outcome. Toxicity of common salt makes this substance a possible means of poisoning, accidental, suicidal or homicidal in origin. There is a report of fatal hypernatremia caused by per oral ingestion of a certain amount of common salt solution by a 70-year old woman, who was unsuccessfully treated at the Neurological Clinic in Niš and whose body was autopsied at the Institute for Forensic Medicine in Niš. Clinically, cerebral symptoms, febricity and hypernatremia (up to 192 mmol/l) were diagnosed and the patient died in comma with brain edema in ME. At autopsy, general congestion of the internal organs, brain and pulmonary edema, subarachnoid and intraparenchimal brain bleeding were present. Histology revealed disseminated micro-hemorrhages and demyelination in basal ganglia, vein micro-thrombosis in the brain and pulmonary tissue, and a characteristic finding of crenated erythrocytes in the bone marrow. Taking into account the results of both clinical and post-mortem investigations, and having ruled out other possible causes of the fatal outcome, the death was put down to excessive common salt intake.