Can a patient drink salt water?

Can a Patient Drink Salt Water?

No, patients should not drink salt water—acute ingestion of concentrated salt solutions can cause fatal hypernatremia, with deaths documented from as little as 5 teaspoons of salt in children and 4 tablespoons in adults. 1, 2

Critical Safety Concerns

Fatal Toxicity Risk

• Salt water ingestion is extremely dangerous and potentially lethal. Case reports document 35 fatalities (19 adults, 16 children) from acute salt ingestion, with 50% mortality in systematic reviews 3, 2
• The lethal dose can be surprisingly small: less than 10 g sodium (approximately 5 teaspoons of salt) in children and less than 25 g sodium (approximately 4 tablespoons) in adults 2
• One documented case involved a patient who consumed approximately 70-90 g of table salt in a supersaturated salt water solution, resulting in a serum sodium of 209 mEq/L and death within 3 days despite treatment 1

Mechanism of Harm

• Acute massive salt ingestion causes severe hypernatremia capable of causing irreversible neurological injury, seizures, and cerebral herniation 3, 4
• The initial serum sodium concentration and patient age are the most important prognostic indicators—even with aggressive treatment, outcomes are often fatal 1

When Salt/Sodium Intake IS Appropriate

Specific Medical Conditions Requiring Increased Salt

The only scenarios where increased salt intake is recommended involve specific medical conditions with careful dosing:

Vasovagal Syncope

• In selected patients with recurrent vasovagal syncope and no contraindications (hypertension, renal disease, heart failure), encouraging 6-9 g of salt per day (approximately 1-2 heaping teaspoonfuls) with 2-3 L of fluid may be reasonable 5
• This must be contraindicated in patients with hypertension, renal disease, heart failure, or cardiac dysfunction 5

Short Bowel Syndrome/High-Output Stomas

• Patients should use salt liberally in relation to meals 5
• An isotonic high-sodium oral rehydration solution (120 mmol/L sodium chloride with 30 mmol/L glucose) should be used to replace stoma sodium losses 5, 6
• This is NOT drinking salt water—it is a carefully formulated oral rehydration solution 6

Dehydration from Gastrointestinal Losses

• WHO-recommended oral rehydration solution contains 90 mmol/L sodium (not concentrated salt water) 6
• Popular beverages like apple juice, sports drinks, and commercial soft drinks should NOT be used for rehydration 6

Conditions Where Salt Should Be RESTRICTED

Hypertension and Heart Failure

• Sodium chloride intake should be no more than 6 g per day in arterial hypertension or acute decompensated heart failure 5
• In patients admitted for acute decompensated heart failure, sodium should not be restricted below 120 mmol/day (2.8 g sodium chloride per day) 5

Liver Cirrhosis with Ascites

• Dietary salt should be restricted to a no-added salt diet of 90 mmol/day (5.2 g salt/day) 5
• Severe salt restriction (22 or 50 mmol/day) is no longer recommended as it may lead to protein malnutrition 5

Critical Pitfalls to Avoid

Never Use Salt Water as an Emetic

• Salt water should never be used to induce vomiting—this obsolete practice has caused multiple documented fatalities 1, 4
• One adolescent died from cerebral herniation after being given salt water as an emetic, developing a serum sodium of 195 mmol/L 4

Avoid Tap Water in Healthcare Settings

• Patients should not drink or rinse their mouth with tap water before collecting sputum specimens due to risk of nontuberculous mycobacterial contamination 5
• Patients with indwelling central catheters should avoid tap water contact with their catheter 5

Proper ORS Preparation

• Improper dilution of oral rehydration solution packets has caused fatal hypernatremia—always follow exact reconstitution instructions 7

In summary: Salt water ingestion is dangerous and potentially fatal. Any therapeutic use of increased sodium must involve carefully measured amounts in specific medical conditions under medical supervision, never concentrated salt water solutions.