We present the first reported case of severe salt poisoning in an extr
emely low birth weight neonate. The salt poisoning was managed with th
e careful use of intravenous fluids, insulin to manage the severe hype
rglycemia, and furosemide to induce a saline diuresis. The hypertonici
ty was normalized slowly over 3 days by following the corrected serum
sodium (Na) (serum Na + 2.7 mEq for every 100 mg/dl of glucose over 10
0). No neurological damage was seen in our patient during the developm
ent of the hypertonicity or its correction. This suggests that the pre
mature brain can develop osmo-protective molecules if hypertonicity de
velops slowly over 2-3 days. Slow correction is therefore recommended
to avoid the development of water intoxication during correction. Desp
ite the development of mild reversible renal failure, a large saline d
iuresis was induced with furosemide, thereby avoiding the need for dia
lysis in our patient. The only complication was the development of nec
rotizing enterocolitis, which has not been previously reported in asso
ciation with salt poisoning.