Successful Rescue of Deep Coma, Shock, and Arrhythmia Caused by Bittern Poisoning

Bittern has been used as the main ingredient of tofu coagulant, and poisoning events usually occurred in the rural of North China. Bittern intoxication may induce electrolyte imbalances, the most important of which is hypermagnesemia, and may be fatal if ingested. The patient without any medical history presented with sinoatrial block, atrioventricular block, paroxysmal atrial tachycardia, and atrial fibrillation on electrocardiography over a short period. The initial diagnosis was unclear and the treatment was difficult. Arterial blood gas analysis indicated severe metabolic acidosis. Her serum concentration of magnesium and chlorine attained 15.14 mEq/L and 130 mEq/L, respectively. After supportive therapy and continuous veno-venous hemofiltration sessions, we observed full recovery without any sequelae. After regaining consciousness, the patient reported ingesting "brine," confirming the diagnosis of "brine poisoning." To the best of our knowledge, such sever hyperchloremia after bittern intoxication has not been previously reported in the literature. However,successful rescue of severe hypermagnesemia in Chinese patients by treatment has only rarely been reported in the current literature.