bittern is made from marine water after extraction of salts , and its gravity is 1.3 . its major components include magnesium chloride , magnesium sulfate , potassium chloride , sodium chloride , and magnesium bromide . bittern has long been used as a main ingredient for tofu coagulant and chemical weapons . we report a case of suicidal intake of bittern and its toxic symptoms with review from literatures . a 73-year - old woman arrived to the emergency department after an attempt suicide by taking five zolpidem pills and bittern of unknown amounts . the patient was oriented to time , place and person and normal muscle power and sensory in the extremities . her initial blood pressure was 149/94 mmhg , pulse rate 82 beats / min , respiratory rate 28 breaths / min and body temperature 36.0 c . electrocardiograph shows qt interval prolongation complete blood counts showed white blood cell ( wbc ) counts 1,249/ml , hemoglobin ( hb ) 16.9 g / dl and platelet counts 265,000/ml . in addition , the arterial blood gas analysis ( abga ) showed ph 7.36 , pco2 35.0 mmhg , po2 68.6 mmhg , hco3 19.2 mmol / l , o2 saturation 92.4% , glucose 145 mg / dl , blood urea nitrogen ( bun ) 13.6 mg / dl , creatinine 0.77 mg / dl , aspartate aminotransferase ( ast ) 49 iu / l , alanine aminotransferase ( alt ) 27 iu / l , albumin 5.5 g / dl , c - reactive protein ( crp ) 0.09 mg / dl , [ na ] 149 meq / l , [ cl ] 120 meq / l and [ mg ] 7.8 meq / l . zolpidem was measured as 0.12 mg / l on urinalysis and 0.94 mg / l on serum biochemistry . brain ct taken right after the visit revealed no evidences of acute brain hemorrhage and following mri showed no evidences of acute infarction . hypernatremia and hyperchloremia were corrected by infusion of half - saline and hypermagnesemia was corrected by injection of 10% calcium gluconate 20 ml . a repeat blood test 12 h later showed decreasing levels of [ na ] , [ k ] , [ cl ] , and [ mg ] to 144 , 4.3 , 120 , and 3.2 meq / l , respectively . following further improvement of the electrolyte measurements , the patient was transferred to the general ward for conservative treatment . all electrolyte measurements returned to normal 4 days after the incident ( [ na ] 138 meq / l , [ k ] 3.8 meq / l , [ cl ] 109 meq / l , and [ mg ] 2.4 meq / l ) . the patient was transferred to the psychiatric ward for further evaluation and management of suicide attempt . the normal content of mg in the body is approximately 22.6 g and 50 - 60% is located in the bone . it is one of the major intracellular divalent cations that are mostly found in the intracellular space . the normal recommended daily intake of mg is approximately 420 mg / day in adult men and 320 mg / day in adult women . the normal range of serum mg is between 1.7 and 2.3 mg / dl ( 0.75 - 0.95 mmol / l ) with 80% being filtered in the glomerulus but only 3% is excreted in the urine . mg metabolic derangement is associated with diabetes mellitus , chronic renal failure , nephrolithiasis , osteoporosis , aplastic osteopathy , and cardiovascular diseases . hypermagnesemia commonly occurs as a result of the overdosing of magnesium salts or magnesium - containing drugs ; this is notable in patients with renal function insufficiency . a level of 5 - 8 meq / l may result in nausea , flushing , headache , hyporeflexia , and lethargy . a level of 9 - 12 meq / l may result in somnolence ; loss of deep tendon reflexes ; prolongation of qrs , pr , and qt intervals ; bradycardia ; and hypotension . a level above 15 meq / l may result in complete heart block , respiratory paralysis , coma and shock . , patients with bittern poisoning should receive adequate fluid infusion and correction of electrolyte imbalances . diuretics or dialysis are recommended for patients with renal failure . as evident in the case reported , early diagnosis and treatment is essential for improvement of the patient 's condition . it is mandatory to serially monitor the electrolyte levels and electrocardiograph to prevent more serious complications such as respiratory paralysis , coma , shock , or death .
bittern is made from marine water after extraction of salt , and its major components include magnesium chloride , magnesium sulfate , potassium chloride , sodium chloride and magnesium bromide . for a long time , it has been used as the main ingredient of tofu coagulant and chemical weapons . 
 a 73-year - old woman arrived to the emergency department after a suicide attempt by drinking an unknown amount bittern . 
 she complained of dizziness , general weakness , and altered mental state ( glasgow coma scale ( gcs ) 13/15 ) . 
 the brain computed tomography ( ct ) and magnetic resonance imaging ( mri ) showed no abnormality . 
 but blood chemistry showed hypermagnesemia ( [ mg2 + ] 7.8 meq / l ) and hypernatremia ( [ na+ ] 149 
 meq / l ) . 
 electrocardiograph showed qt prolongation of 0.482 s. electrolyte imbalances were corrected following adequate fluid therapy and injection of calcium gluconate . 
 the patient recovered / was subsequently discharged without any complications . 
 electrolyte imbalances are a common presentation following bittern poisoning . 
 severe side effects like respiratory depression , hypotension , arrhythmia , bradycardia , and cardiac arrest can also occur . 
 patients will require immediate fluid therapy and correction of electrolyte imbalances . 
 the symptoms vary depending on the electrolyte levels . 
 it is mandatory to closely monitor the electrolyte levels and electrocardiograph in these patients .