Water intoxication
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Water intoxication (also known as hyper-hydration or water poisoning) is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside of safe limits by over-consumption of water.[1] Normal, healthy (both physically and nutritionally) individuals have little reason to worry about accidentally consuming too much water. Nearly all deaths related to water intoxication in normal individuals have resulted either from water drinking contests, in which individuals attempt to consume high amounts of water, or long bouts of intensive exercise during which electrolytes are not properly replenished, yet excessive amounts of fluid are still consumed.[2]
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[edit] High risk factors
[edit] Gastroenteritis, particularly in infants and children
The severe diarrhea and vomiting associated with gastroenteritis can result in very large electrolyte losses. Gastroenteritis due to infectious agents (primarily rotavirus), is a major cause of infant and child death. Management of gastroenteritis requires replacing water and electrolytes in proportions that avoid both dehydration and water intoxication. Drinking water will replace lost water and avoid a dehydration, but if the person is unable to take any other drink or food then lost electrolytes will not be replaced, which can result in water intoxication. Replacement fluids for vomiting and diarrhea should be properly balanced to make them isotonic with the fluids lost in these conditions. Special formulations exist for oral rehydration therapy in these cases.
[edit] Low body mass (infants)
It can be very easy for children under 1 year old to absorb too much water, especially if the child is under nine months old. Because of their small body mass, it is easy to take in a large amount of water relative to body mass.[3]
[edit] Endurance sports
Marathon runners are susceptible to water intoxication if they drink too much while running. This is caused when sodium levels drop below 135 mmol/L when athletes consume large amounts of fluid. This has been noted to be the result of the encouragement of excessive fluid replacement by various guidelines. This has largely been identified in marathon runners as a dilutional hyponatremia. Medical personnel at marathon events are trained to immediately suspect water intoxication when runners collapse or show signs of confusion.
[edit] Overexertion and heat stress
Any activity or situation that promotes heavy sweating can lead to water intoxication when water is consumed to replace lost fluids. Persons working in extreme heat and/or humidity for long periods must take care to drink and eat in ways that help to maintain electrolyte balance. People using drugs such as MDMA ("Ecstasy") may overexert themselves, perspire heavily, and then drink large amounts of water to rehydrate, leading to electrolyte imbalance and water intoxication. Even people who are resting quietly in extreme heat or humidity may run the risk of water intoxication if they drink large amounts of water over short periods for rehydration.
[edit] Psychiatric conditions
Psychogenic polydipsia is the psychiatric condition in which patients feel compelled to drink large quantities of water, thus putting them at risk of water intoxication. This condition can be especially dangerous if the patient also exhibits other psychiatric indications (as is often the case), as his or her care-takers might misinterpret the hyponatremic symptoms.
[edit] Medical conditions
Many disorders can affect electrolyte balance, especially disorders of the kidneys. Diuretic therapy, mineralocorticoid deficiency, osmotic diuresis (as in the hyperglycemia of uncontrolled diabetes), and the multiple disorders associated with AIDS are other common causes of electrolyte imbalance, although they do not always produce water intoxication.
[edit] Iatrogenic
When an unconscious person is being fed intravenously (for example, total parenteral nutrition or via a nasogastric tube) the fluids given must be carefully balanced in composition to match fluids and electrolytes lost. These fluids are typically hypertonic, and so water is often co-administered. If the electrolytes are not monitored (even in an ambulatory patient) either hypernatremia or hyponatremia may result.
Some neurological/psychiatric medications (Oxcarbazepine, among others) have been found to cause hyponatremia in some patients.[citation needed] Patients with diabetes insipidus are particularly vulnerable due to rapid fluid processing.
[edit] Treatment
Mild intoxication may remain asymptomatic and require only fluid restriction. In more severe cases, treatment consists of:
- Diuretics to increase urination, which are most effective for excess blood volume
- Vasopressin receptor antagonists
[edit] Prevention
Water intoxication can be prevented if a person's intake of water does not grossly exceed his or her losses.[citation needed] Healthy kidneys are able to excrete approximately 1 liter of fluid per hour. However, stress (from prolonged physical exertion), as well as disease states, can greatly reduce this amount.
Sports drinks are popular among athletes because they provide electrolytes to support extended exercise. However most sports drinks are hypotonic and do not contain enough electrolytes to balance excessive intake.[citation needed] Additionally, most contain excessive sugars, which predispose to diarrhea.[citation needed] And most omit starches, though starches are superior for achieving hydration.[citation needed]
Water intoxication should not be confused with dehydration, a loss of fluids (with decreased, normal, or increased electrolytes). However, drinking to satisfy one's thirst prevents both conditions.[citation needed]
[edit] Notable cases
- Artist Andy Warhol died from a cardiac arrhythmia. His family sued the hospital, claiming the arrhythmia was a result of water intoxication from being overloaded with fluids after routine gallbladder surgery.[4]
- Leah Betts died on November 16, 1995 as the result of drinking too much water, though in the media her death was initially attributed to taking an ecstasy tablet at her 18th birthday party.[5]
- On September 12, 1999, US Air Force basic trainee Michael J. Schindler died of heat stroke, severely complicated by water intoxication, two days after becoming seriously ill during a 5.8 mile march. The Air Force changed its recruit training procedures as a result.[6]
- On June 9, 2002, 4-year-old Cassandra Killpack of Springville, Utah died as a result of water intoxication when her parents forcefully fed her as much as one gallon (3.8 liters) of water in a short period while she was being disciplined. Her parents, Richard and Jennette Killpack, were convicted in 2005 of child abuse homicide.[7]
- On October 12, 2002, 3-year-old Rosita Gonzalez of Hollywood, Florida died of water intoxication when her babysitter Nancy Gayoso punished her by forcing her to drink three quarts (2.8 liters) of water in a four-hour period.[8][9] Gayoso was charged and arrested for murder in the first degree on March 10, 2003. After being declared incompetent to stand trial in 2004 and 2005,[10] Gayoso was found competent on March 26, 2007.
- In 2003, Walter Dean Jennings, a freshman history major at SUNY Plattsburgh, was pledging the Psi Epsilon Chi "when he was forced to drink urine, stay awake for days and consume vast amounts of alcohol during a 10-day initiation and hazing process." According to PressRepublican.com, "On his last night of pledging the unrecognized fraternity, the 18-year-old was forced to drink gallons of water through a funnel, which caused his brain to swell from water intoxication and ultimately resulted in his death."[11]
- In a much-publicized case of fraternity hazing, four members of the Chi Tau House at California State University, Chico pleaded guilty to forcing 21-year-old student Matthew Carrington to drink excessive amounts of water while performing calisthenics in a frigid basement as part of initiation rites on February 2, 2005.[12] He collapsed and died of heart failure due to water intoxication.
- On January 12, 2007, Jennifer Strange, a 28-year-old woman and a mother of 3, from Rancho Cordova, California, was found dead in her home by her mother, hours after trying to win one of Nintendo's Wii game consoles. KDND 107.9 "The End" radio station's "Hold Your Wee for a Wii" contest, involved drinking large quantities of water without urinating. Civil charges against the radio station were filed by Jennifer's family,[13] and the family was eventually awarded $16.5 million in the ensuing wrongful death lawsuit.[14] The FCC has launched its own investigation to determine if the station violated the terms of its operating license.
- In 2008, Jacqueline Henson, a 40-year-old British woman, died after drinking four litres of water in under two hours as part of her LighterLife diet plan.[15]
- Other notable fatalities due to water intoxication include Australian schoolgirl Anna Wood,[16] 2002 Boston Marathon competitor Cynthia Lucero,[17] and Washington, D.C. police officer James McBride.[18]
[edit] See also
- Electrolytes
- Hyponatremia
- Hypernatremia
- Gastroenteritis
- Oral rehydration therapy
- Polydipsia
- Water urticaria
- Dihydrogen Monoxide
- Electrolyte imbalance
[edit] References
- ^ Bird, Patrick J. (2000). "You Can Drink Too Much Water". University of Florida. http://www.hhp.ufl.edu/faculty/pbird/keepingfit/ARTICLE/toomuchwater.htm. Retrieved 2007-01-21.
- ^ a study refers to a kidney excreting capacity of 900 ml/hr
- ^ Water Intoxication in Infants
- ^ New York Times December 5th 1991
- ^ "Hyponatremia ("Water Intoxication")". The DEA.org. http://thedea.org/hyponatremia.html. Retrieved 2007-05-10.
- ^ Grier, Peter (January 2000). "Airman's Death Brings Training Changes". Aerospace World (Air Force Magazine Online). http://www.afa.org/magazine/Jan2000/0100world.asp#anchornine. Retrieved 2007-01-20.
- ^ "Split verdict surprises and stuns the Killpacks". Deseret News. October 13, 2005. http://deseretnews.com/dn/view/0,1249,630152910,00.html. Retrieved 2008-08-24.
- ^ Local10.com/WPLG report of water intoxication murder arrest
- ^ Sun-Sentinel article: Nancy Gayoso declared competent to stand trial
- ^ Local10.com/WPLG report: "Judge: Baby Sitter in Water Intoxication Death Still Not Competent"
- ^ http://www.pressrepublican.com/homepage/local_story_339013010.html
- ^ Lore, Mark (2005-02-10). "Another death in the family". Chico news & review. http://www.newsreview.com/chico/Content?oid=oid%3A33779. Retrieved 2007-05-10.
- ^ "Woman dies after water-drinking contest". MSNBC. January 13, 2007. http://www.msnbc.msn.com/id/16614865/. Retrieved 2007-05-10.
- ^ "Calif. jury awards $16M in radio contestant death". AP. October 29, 2009. http://www.google.com/hostednews/ap/article/ALeqM5gmq1VMKNn6r211Pxd0nvBFVIrviwD9BL1NFG0. Retrieved 2009-10-29.
- ^ "Woman died from 'too much water'". BBC News. 2008-12-12. http://news.bbc.co.uk/1/hi/england/bradford/7779079.stm.
- ^ "Reasons for dispensing with the holding of an inquest". http://www.erowid.org/chemicals/mdma/mdma_health5.shtml. Retrieved 2007-05-10.
- ^ "Doctors: Marathoner Died From Too Much Water". August 13, 2002. http://www.thebostonchannel.com/newscenter5/1610699/detail.html. Retrieved 2007-05-10.
- ^ "District Officer Dies After Bike Ride: Over-Hydration Cited as Factor". http://www.washingtonpost.com/wp-dyn/content/article/2005/08/10/AR2005081001460.html.
