A Systematic Review of Fatalities Related to Acute Ingestion of Salt. A Need for Warning Labels?

Norm R. C. Campbell and Emma J Train

Globally a high salt intake is the leading dietary risk for death and disability, which are largely related to hypertension or gastric cancer. Recently marketing campaigns such as #Salt4Syria, which tasked participants to ‘taste’ a spoonful of salt, or the ‘eat salt challenge’ which challenged participants to consume a tablespoon of salt, have caused isolated cases of extremely high salt intake.  Therefore this systematic review focuses on another potential danger of dietary salt - acute toxic effects.

The authors searched for all studies that reported fatalities from salt intake and categorised fatalities by age:

Age

Sodium/salt intake and reason for high intake

Children (<5 years)

15 fatalities  

  • 8 cases - salt was mistake for sugar
  • 4 cases - salt was used as an emetic (induce vomiting)
  • 3 cases - abuse cases

Most doses were unknown but reported doses were 7g to 13g of sodium (17.8-33g salt)

Children (5-10 years)

1 fatality

A girl was fed a minimum of 5 teaspoons of salt by her parents, equivalent to 11.4g sodium or 29g salt

Adolescents (10-18 years)

No reported fatalities

Adults (age range 19-83)

19 reported fatalities

  • 8 cases - salt was used as an emetic
  • 2 cases -emetic and lavage
  • 2 cases - healthcare professional administered emetic
  • 3 cases - salt was mistaken for sugar
  • 3 cases - exorcism rituals
  • 1 case - unknown

 

In 2 children the lethal dose of sodium was less than 10g which is less than 5 teaspoons of salt. In 4 adults, the lethal dose was less than 25g sodium which is less than 4 tablespoons of salt, and is just twice as high as the upper range of daily salt consumption in the Chinese population. Fatality was linked to hypernatremia, which is a high sodium level in blood at a level ≥145mmol/l.

Although the sodium content of food is lower and is absorbed more slowly than salt by itself or in a solution, and therefore is generally considered ‘safe’ as a food additive, the authors suggest that warning labels on salt may increase awareness of the dangers of high salt consumption and discourage ‘salt challenges’ or rituals.

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