English
Baking soda is a household product composed of sodium bicarbonate. It can be used as a home remedy for indigestion. If used in excess, baking soda may cause various serious metabolic abnormalities. We believe that this is the first case of hemorrhagic encephalopathy caused by ingestion of baking soda. So everyone should also pay attention to the dangers of misuse of baking soda and related adverse effects.
This passage is going to talk about the followings of sodium bicarbonate:
(1) Introduction to sodium bicarbonate
(2) Discuss the safety of sodium bicarbonate
(3) Clinical manifestations
Baking soda is sold to consumers for many households and personal purposes. Its active ingredient is sodium bicarbonate.
Although proton pump inhibitors and H2 blockers are widely used, baking soda continues to be used as an antacid to stop indigestion. The recommended dosage of baking soda as an antacid is to add 1/2 teaspoon teaspoon to 4-8 ounces of water every 2 hours. Each teaspoon of baking soda contains 41.8mEq of sodium. 1 Appropriate use of sodium bicarbonate is generally safe. However, if abused, it may produce obvious toxicity. Metabolic alkalosis, hypernatremia, hypokalemia, hypochloremia and hypoxia have been reported. Two severe hypernatremia can cause neuronal cell atrophy, brain tissue shrinkage and potential intracranial hemorrhage. We present a case of severe metabolic alkalosis and hypernatremia hemorrhagic encephalopathy after acute and deliberate inhalation of baking soda.
Pathophysiology
Baking soda toxicity can cause high sodium metabolic alkalosis, accompanied by hypochlorite, hypokalemia, and urine alkalization, all of which are present in our patients. Healthy adult subjects under 60 years old with normal renal function and 3-7 years old can tolerate 1700mEq of sodium bicarbonate with very few symptoms. 8 Our patient has taken about 5,403mEq of sodium. Increased serum bicarbonate after ingestion leads to increased renal excretion, which is called bicarbonate diuresis. 3, 9, 10 This diuretic effect is accompanied by the loss of chloride, sodium, potassium and water. However, when a large amount of intake is ingested, a large amount of free water may be lost, which will cause the glomerular filtration rate (GFR) to be impaired and ultimately reduce the bicarbonate filtration rate.
Central nervous system (CNS) hypernatremia causes water to seep out of neurons, causing cell dehydration and neuronal cell atrophy. The loss of brain volume causes the tissues in the skull to retract. The increased tension of the dural bridging veins leads to rupture of the vascular structure and eventually intracranial hemorrhage, which occurs in the subdural space in most cases.
Certain populations are at higher risk of complications related to the abuse of baking soda, including alcohol abuse (due to physical exertion associated with insufficient oral intake and chronic vomiting), the elderly, patients with hypovolemia, and potentially pulmonary or Patients with kidney disease. [ncbi]
Baking soda toxicity can exist in many ways. The most common cases are nausea, vomiting and abdominal pain. 16 However, 1-5% of patients will experience neurological symptoms such as drowsiness, drowsiness, nystagmus, seizures, weakness and rarely coma. It is reported that there are 12 cases of arrhythmia and cardiopulmonary arrest, and a pregnant woman developed baking soda powder at 37 weeks of gestation, and developed rhabdomyolysis and perinatal cardiomyopathy. The spontaneous rupture of sodium bicarbonate in the stomach after intake of sodium bicarbonate on 5, 15, and 17 is believed to be due to increased CO 2 production after the reaction of bicarbonate with acidic gastric contents has been reported.
Reports of cerebral hemorrhage caused by hypernatremia are rare. It is understood that no cases of cerebral hemorrhage and hypernatremia caused by ingestion of baking soda have been found. Hypernatremia hemorrhagic encephalopathy in newborns and children is usually related to dehydration and/or medication. The sodium content in this case usually exceeds 160mmol/L. The first case of adult hypernatremia hemorrhagic encephalopathy was reported in 2010 from 19-22, which was the result of hypernatremia caused by hypotonic fluid loss. [ncbi]
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