most of the known hypernatremic cases are due to a loss of water rather than due to excessive salt intake . it is reported that in ancient china , saturated salt solutions were used as a traditional suicide method . the causes of high salt intake induced hypernatremia were gastric lavage with high salt solution , excessive salt intake , intravenous infusion of hypertonic saline , forced salt intake in cases of child abuse or exorcism1 ) and accidental sodium chloride ingestion due to inadvertent prepa ration of child food with salt instead of sugar2 ) . recently , a case of severe hypernatremia caused by excessive salt intake as folk remedies for 3 months in a patient with chronic kidney disease had been reported in korea3 ) . however , severe hypernatremia in a healthy young adult with clear consciousness and normal renal function had not been reported in korea yet . we report a case of a healthy young woman with acute severe hypernatremia caused by excessive bamboo salt intakes as folk remedies . she ingested bamboo salt ( about 150 grams ) in a day for the purpose of digestion and weight reduction . after that , she had more than ten episodes of vomiting and diarrhea for 2 - 3 hours . on arrival at our emergency department , vital signs were blood pressure of 128/81mmhg , heart rate of 75 beat / min , respiration rate of 20/min , and body temperature of 37.3. her consciousness was clear but she complained of generalized weakness . the complete blood counts showed hemoglobin 11.3 g / dl , wbc 10,000 cells/l , and platelet 196,000/l . the results of her blood chemistry were as follows : aspartate transaminase 11 iu / l , alanine transaminase 9 iu / l , total protein 6.4 g / dl , albumin 4.5 g / dl , blood urea nitrogen 5.2mg / dl , and creatinine 0.57mg / dl . serum sodium , potassium and chloride were 174meql / l , 3.6meq / l and 135meq / l respectively . urine sodium , potassium , chloride and osmolarity were 440meq / l , 125.7 meq / l , 314meq / l and 841mosm / kg , respectively . on arterial blood gas analysis , ph was 7.32 , paco2 36mmhg , bicarbonate 18.5meq / l , pao2 93mmhg and o2 saturation 97% . on the 1 day , total input and urine output was 3,700ml and 2,100ml , respectively . her symptoms such as nausea , vomiting and diarrhea improved rapidly with 0.45% saline infusion and supportive care . on the 2 day , her serum sodium concentration dropped to 152 meq / l and urine output was 2,200ml / day . on the 3 day , serum sodium concentration returned to normal range ( fig 1 ) . hypernatremia is characterized by a decrease in total body water relative to total body electrolyte contents resulting in the increase of sodium concentration of extracellular fluids . recently , hypernatremia resulting from excessive sodium intake have been described after using salt as folk remedies for three months in a patient with chronic kidney disease in korea3 ) . in korean fork remedies , bamboo salt was believed to have many beneficial effects on digestion , inflammation , detoxification and so on . sohn et al . showed that bamboo salt had anti - plaque and anti - inflammatory effect on oral hygiene used as dentifrices4 ) . sea salt is stuffed into bamboo tubes , and the ends are plugged with mud ; the assembly is roasted one or more times to make bamboo sat . it is believed that the trace elements in the mud and bamboo are thought to make this form of salt healthier . however yoo et al . reported that bamboo salt had no effects on the general pharmacology of central nervous systems and cardiovascular system5 ) . so it is probably reasonable that bamboo salt maybe regarded as sodium chloride salt in the pharmacologic aspect . the mortality of hypernatremia is very high . in general , doses greater than 1 g sodium chloride per kg body weight can lead to raised blood sodium concentration by 30mmol / l6 - 8 ) . serum sodium levels above 160meq / l have been associated with a high mortality rate ( 9 - 35% ) and neurological damage9 - 11 ) . moreover , extreme hypernatremia ( > 190meq / l ) has a high mortality rate up to 62% for children12 ) . ofran et al . described highest sodium plasma level of 255meq / l in a female with psychiatric disorder7 ) . acute hypernatremia should be treated with rapid rate of serum concentration of 1 - 2meq / l / h , whereas chronic hypernatremia should be treated with a slower rate of sodium concentration of 0.5meq / l / h . however , the overcorrection of hypernatremia might cause severe complications , because some acute hypernatremia can not be differentiated from chronic hypernatremia14 ) . the serum sodium concentration on admission day ( 174meq / l ) decreased to 152meq / l within 1 day . we assume that her young age and healthy condition contributed to this favorable result15 ) . in summary , we present here a case of severe hypernatremia by excessive bamboo salt ingestion in a healthy young woman with clear consciousness and completely recovered without any sequalae .
severe hypernatremia is an important electrolyte disorder that has serious effects . 
 the patient had no medical history . 
 a. 20-year - old ingested bamboo salt for digestion and weight reduction according to the folk remedies posted on an internet website . 
 she presented with vomiting and diarrhea over ten times per day . 
 her initial serum sodium concentration was 174meq / l . her symptoms improved rapidly with hypotonic saline infusion . 
 she recovered completely without any sequelae in three days . 
 severe hypernatremia in a normal young adult with clear consciousness and normal renal function has not been reported in korea yet . 
 so we report a case of severe hypernatremia by excessive bamboo salt ingestion in healthy young woman .