Adult could have administered salt that killed girl of four, inquest told
A four-year-old girl died after ingesting as much as seven teaspoons of salt – which could have been administered by an adult, a court has heard.
The little girl suffered from acute hypernatraemia due to the excess sodium in her bloodstream and died at the Royal Hospital for Sick Children in Belfast nearly five years ago.
An inquest into the death of Lindsey Angela Alvarez opened in Belfast yesterday to try to establish how the salt got into her body. The hearing is also looking at whether an adult administered the salt to her, or if the child – who was severely autistic – could have accidentally taken it herself.
The little girl was left in her uncle's care after her mother and aunt, both of whom were staff nurses at the Ulster Hospital, Dundonald, went to work before she became seriously ill with vomiting and diarrhoea several hours later.
She was rushed to the Ulster Hospital's emergency department on July 30, 2009, before being transferred to the intensive care unit of the Royal Children's Hospital, where she was found to be brain-damaged.
The child died on August 4, just weeks before her fifth birthday, when the decision to turn off the life support machine was made.
Coroner Jim Kitson heard that the child, who was the eldest to Filipino parents resident in Northern Ireland, was also found to have sustained several broken ribs and a serious head injury from a fall down the stairs, which also happened under her uncle's care at his Dundonald home on July 25, 2009.
The inquest's barrister David Sharpe said in his opening statements: "There is some debate if the salt was administered by an adult, or if Lindsey, who was diagnosed as having severe autism, could have ingested the salt herself."
Mr Sharpe said it was possible that due to Lindsey's autism she may not have registered the unpleasantness of ingesting the salt, and that two adults, her mother Amelda Alvarez and uncle Michael Valderama, were the only two people directly responsible for her care that morning.
He said that he was bound to caution all witnesses not to answer any questions that may possibly incriminate them, as the death was still the subject of a police investigation.
However, he added that one of his key witnesses, Dr Malcolm Coultard, would say in his evidence that it was his expert opinion that the child ingested as much as five to seven teaspoons of salt sometime in the eight hours leading up to her admission into hospital just after 2pm that day.
Asked if she gave any salt to her daughter, Mrs Alvarez answered: "No, I didn't give any salt to my daughter."
And she said she could not explain how she came to ingest it.
She also said that she had not been concerned that her daughter had been seriously hurt in the earlier fall down the stairs.
Mr Valderama said in response to a police question that he had witnessed the child's father, Angelito Alvarez, known as Jo Jo, slap his wife across the face twice in his company, and also slapping his daughter once across the face, which had greatly upset him.
Mr Valderama broke down while giving evidence when Mr Sharpe asked how concerned he had been about Lindsey that morning.
He said that Lindsey only took one sip of lukewarm water from him that morning, and did not eat anything.