Tuesday, May 15, 2012

Fatal Hypernatraemia from Excessive Salt Ingestion During Exorcism

Scene from The Exorcist (1973)


Now here's something you don't see every day (fortunately!):
Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L−1): a disorder linked to female gender and psychiatric disorders (Ofran et al., 2004).

Excessive ingestion of salt is a well-recognized cause of hypernatraemia in children, is uncommonly recognized in debilitated elderly persons, but is rarely diagnosed in healthy, independent adults. We report a case of fatal salt poisoning in a 20-year-old lady who suffered of post-natal depression and ingested large quantities of salt as part of exorcism ritual. She presented with the highest ever documented serum sodium level of 255 mmol L−1, associated with severe neurological impairment that was unresponsive to aggressive hypotonic fluid replacement. Post-mortem examination ruled out any other possible probable cause of death. The medical literature was reviewed, and 16 previous cases of severe hypernatraemia in adults secondary to excessive salt ingestion were retrieved. Common features of all reported cases included female gender (95% of cases) and evidence of underlying cognitive or psychiatric disorders (all reported cases). We conclude that women with documented cognitive or psychiatric disorders, in particular depression, are susceptible for psychogenic salt poisoning. Awareness should be raised to the potentially life-risking use of salty beverages as emetics or as part of ‘exorcism’ rituals.

Although the patient received a prescription for Prozac to treat her postpartum depression, her family also advised her to undergo an exorcism. She reportedly drank six glasses of a mixture of 1 kg table salt in a liter of water! That's more than what's in your average container of Morton salt.

In another fatal case (Hédouin et al., 1999), a 19 year old woman with post-surgical epilepsy was severely flogged and forced to drink 5 liters of salt water as part of an exorcism. The imam involved in this case was arrested and charged with torture.

A summary of the literature on salt poisoning is presented below (from Ofran et al., 2004).

-- click on image to enlarge --




The third horrific report involved the exorcism of a 36 year old woman forcibly administered 1 kg of salt (Raya et al., 1992):
Five hours after admission, the patient showed clinical criteria of brain death, confirmed by electroencephalogram. Postmortem examination showed evidence of dehydration with a great decrease in the volume of the whole brain, several foci of parenchymal hemorrhage, and subarachnoid hemorrhage. ...

...we cannot rule out the possibility of rectal or vaginal administration of salt in our patient in the context of fanatic superstitious rituals and activities of an exceptional nature as those referred to in the case presented herein.



Pass the unsalted popcorn??


References

Hédouin V, Révuelta E, Bécart A, Tournel G, Deveaux M, Gosset D. A case of fatal salt water intoxication following an exorcism session. Forensic Sci Int. 1999 Jan 4;99(1):1-4.

Ofran Y, Lavi D, Opher D, Weiss TA, Elinav E. Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders. J Intern Med. 2004 Dec;256(6):525-8.

Raya A, Giner P, Aranegui P, Guerrero F, Vazquez G. Fatal acute hypernatremia caused by massive intake of salt. Arch Intern Med. 1992 Mar;152(3):640, 646.

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2 Comments:

At May 16, 2012 3:15 PM, Anonymous Anonymous said...

A clear case of a salt as a deadly weapon.

 
At May 16, 2012 4:31 PM, Blogger The Neurocritic said...

Good one!

 

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