Gastric mucosal necrosis caused by ingestion of crystalline sodium chloride: A case report.

Acute sodium chloride (NaCl) poisoning is a life-threatening condition primarily known to cause systemic hypernatremia. However, the local gastrointestinal effects of ingesting a large mass of crystalline NaCl are not well-documented. This case illustrates that crystalline NaCl can cause a severe corrosive injury pattern akin to that of classic caustic agents. We present a 42-year-old woman with abdominal pain and hematemesis after ingesting 200 g of crystalline NaCl in a suicide attempt. She had hypernatremia (155 mmol/L) and hyperosmolality (serum osmolality 324 mOsm/kg). An upper endoscopy revealed severe corrosive gastritis with mucosal necrosis and exudates, concentrated in the gastric antrum, with relative sparing of the esophagus and duodenum. The patient was managed supportively with intravenous fluids and a proton pump inhibitor, and her gastric lesions showed healing with significant scarring on a follow-up endoscopy. In conclusion, massive NaCl ingestion can cause severe, localized corrosive gastritis, in addition to systemic hypernatremia. The physical form of NaCl (solid crystals) is a critical determinant of injury. Clinicians should maintain a high suspicion for severe gastrointestinal chemical injury.