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Abstract: SA-PO740

Unintended Consequences: Severe Hypernatremia and Metabolic Alkalosis Following Baking Soda Ingestion for Urine Drug Screen Evasion

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Tanariyakul, Manasawee, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Leesutipornchai, Thiratest, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Techasatian, Witina, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Arayangkool, Chinnawat, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Aiumtrakul, Noppawit, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Khan, Mohammad Iqbal, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
  • Izutsu, Christie H., University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, United States
Introduction

Baking soda, also known as sodium bicarbonate, has various uses such as cleaning and treating conditions like metabolic acidosis and acid reflux. However, baking soda overdose can lead to fatal adverse events. We report a case of severe hypernatremia caused by intentional abuse of sodium bicarbonate to alter a urine drug screening (UDS) test result.

Case Description

We report a case of an individual found unconscious in a courthouse restroom. Initial findings revealed hypoglycemia to 55mg/dL and seizure activity upon EMS arrival. The patient was encephalopathic, prompting intubation. Formal laboratory tests showed critical hypernatremia, hypokalemia and metabolic alkalosis with Na>180, K=2.4, Cl=111, CO2>50, pH in blood gas=7.56. Further information was obtained from the patient's mother, revealing that the patient likely ingested baking soda with water before the UDS in an attempt to manipulate the test results. Interestingly, the initial UDS on admission returned negative for methamphetamine, but a repeat test done two days later resulted positive. The nursing staff also found white powder in the patient's bag. After mixing the powder with vinegar, bubbles were observed, raising suspicion of a baking soda ingestion. Sodium correction using D5W and LR, was initiated along with antiepileptic drugs in conjunction with serial lab monitoring to ensure that sodium levels were appropriately lowered. Unfortunately, the patient deteriorated further with development cerebral edema and brain herniation.

Discussion

Metabolic alkalosis occurs from an accumulation of HCO3- or an inability to eliminate excess HCO3-. This case involved a patient with severe hypernatremia and metabolic alkalosis due to exogenous alkali intake from baking soda, presenting with seizures and encephalopathy. The initial blood gas indicated an acute metabolic alkalosis with respiratory compensation. Cytotoxicity resulting from seizure and fluid shifts from rapid changes in sodium levels can explain the cerebral edema. Notably, a simple test demonstrating the reaction between vinegar and baking soda can be done to confirm the substance and may change the clinical course.