• Jonathan Hancher, Joseph Fisher, and Christina Shenvi.
• Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, United States of America.
• Am J Emerg Med. 2020 Aug 1; 38 (8): 1700.e1-1700.e3.

AbstractWe 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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