Severe hypernatremia and gastric dilation from chronic eating disorder and intentional salt ingestion

We report the case of a 21-year-old female presenting with severe hypernatremia and a gastric outlet obstruction due to chronic purging behavior with salt water flushes. She presented obtunded following emesis and a witnessed seizure. She was found to have a corrected sodium level of 177 mmol/L. Following initial intubation and resuscitation, her CT imaging showed massive gastric dilation with high-density material in the gastric lumen. After orogastric flushing was unsuccessful and the patient's abdominal distention worsened, she was managed surgically and found to have a salt bezoar leading to bowel ischemia and perforation. This case details the complications and management of acute hypernatremia and gastric outlet obstruction in an otherwise healthy, young female. In a society where eating disorders are pervasive, Emergency Medicine physicians should be familiar with dangerous dietary behaviors as well as the management of their rare, but potentially life-threatening, complications.