Fatal Acute Hypernatremia Caused by Massive Intake of Salt

To the Editor.— According to their cause, hypernatremic states can be classified into two groups. The first group, by far the more frequent, is due to the loss of simple water, or hypotonic liquid in the case of dehydration, usually in elderly people. 1 The second, less frequent group, is related to the increase in salt intake, generally of an iatrogenic nature. 2,3 We are presenting a case of fatal hypernatremia caused by massive ingestion of salt. Report of a Case.— A 36-year-old woman, previously healthy, was brought in a comatose state to the emergency department of our hospital. Her family reported that, during the previous 24 hours, she had participated in a supposed "exorcism," during which she had ingested large quantities of sodium bicarbonate and salt (approximately 1 kg of salt dissolved in water). Physical examination showed a comatose patient with multifocal myoclonus, small and reactive pupils, presence of