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Recognition and Management of Pediatric Salt Toxicity

Blohm, Eike, MD*; Goldberg, Amy, MD; Salerno, Ann, MD; Jenny, Carole, MD, MBA§; Boyer, Edward, MD, PhD; Babu, Kavita, MD*

doi: 10.1097/PEC.0000000000001340
Review Article

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.

From the *Division of Toxicology, Department of Emergency Medicine, University of Massachusetts;

Hasbro Children's Hospital, Brown University;

Division of Nephrology, Department of Medicine, University of Massachusetts;

§Department of Pediatrics, University of Washington; and

Division of Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital.

Disclosure: The authors declare no conflict of interest.

Reprints: Eike Blohm, MD, 7 Monomoy St, Worcester, MA 01606 (e-mail: eike.blohm@gmail.com).

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.