In the July 1993 issue of the Archives, Yercen et al1 describe an unusual cause of salt poisoning in a 30-day-old Turkish girl whose skin, according to an old Turkish custom, was chronically salted. She presented with seizure activity and a serum sodium concentration of 196 mmol/L. Therapy included administration of intravenous fluid, resulting in a decrease in the serum sodium concentration from 196 to 152 mmol/L within 12 hours, a gradual decline according to the authors. During this period, the patient had uncontrollable seizures and died after 23 hours. In the absence of a postmortem examination of her brain, the authors believe the patient died of central nervous system hemorrhage due to hypernatremia.
I postulate that an equally likely cause of death in this already critically ill infant was water intoxication with brain herniation. There are two special characteristics of the central nervous system that support this diagnosis.