P3.221: Sugar, Spice, and Baking Soda?

Introduction: Depending upon the culture in which one was raised, many home remedies are often tried as a quick treatment for ailments. Although most of the time these home remedies pose little risk, they can have unintended side effects. We present a patient who consumed a common household item that is used in baked goods, as a teeth whitener, antacid, or even as an air freshener. The patient and their family were unaware of the severe consequences that could ensue after chronic overconsumption of this substance.

Case Description: A previously healthy 15-year-old female presented after 5 days of emesis and poor oral intake despite taking ondansetron with no improvement. She reported occasional marijuana use. The remainder of her history was non-contributory aside from eating homemade candy and large quantities of hot sauce. Later during admission, she reported consuming 2 teaspoons of baking soda daily for the last 2-3 years but then admitted to consuming baking soda in place of meals about 3 times per week which had worsened over the prior 2 months. She had consumed a 13 lb box of baking soda during this time. This was about the time her best friend died from suicide. Initial labs showed hypernatremia (149), hypokalemia (3.1), AKI (Cr 1.12), metabolic alkalosis (HCO3 32), mild transaminitis, and prolonged QTc (540). She was initially treated conservatively with IVF of D5W with 20 mEq KCl, scopolamine patch, and granisetron. Despite providing D5W and potassium supplementation, she had persistent hypernatremia (151) and hypokalemia (2.8). Given her history of chronic baking soda ingestion, adrenal, renal, and pituitary hormone labs were obtained and were unremarkable. Upper endoscopy showed severe esophagitis and gastritis. Biopsies were positive for H. pylori following discharge.

Discussion: Our patient’s presentation was multifactorial. The consumption of hot sauce likely contributed to severe esophagitis and gastritis from an underlying H. pylori infection. The ingestion of sodium bicarbonate could have started as a combination of sensory pleasure and source of symptomatic relief for her esophagitis and gastritis. It is unclear if what started as a home remedy for indigestion became more compulsory after the death of her best friend. There was no evidence of salt wasting, underlying renal or pituitary disease requiring exogenous sodium supplementation.

Conclusion: Each teaspoon of baking soda contains 59 mEq of sodium bicarbonate compared to OTC “salt tablets” which contain 7.7 mEq of sodium bicarbonate. Chronic sodium consumption, particularly sodium bicarbonate, can lead to electrolyte disturbances, such as hypernatremia and hypokalemia which most likely caused her prolonged QTc. After cessation of baking soda ingestion, her QTc normalized. She was started on high dose PPI and was placed on a low salt diet. She was started on triple therapy for H. pylori infection as her biopsies resulted after discharge.