Water intoxication
Encyclopedia
Water intoxication, also known as water poisoning, is a potentially fatal disturbance in brain
functions that results when the normal balance of electrolyte
s in the body is pushed outside of safe limits by over-consumption of water
.
Under normal circumstances, accidentally consuming too much water is exceptionally rare. Nearly all deaths related to water intoxication in normal individuals have resulted either from water drinking contests in which individuals attempt to consume large amounts of water, or long bouts of intensive exercise during which electrolytes are not properly replenished, yet excessive amounts of fluid are still consumed.
Water can be considered a poison
when over-consumed just like any other substance in a specific period of time. Water intoxication mostly occurs when water is being consumed at a high quantity without giving the body its proper nutrients it needs to be healthy.
and other electrolytes) in comparison to that inside the cells causing the fluid to shift through ( via osmosis
) into the cells to balance its concentration. This causes the cells to swell. In the brain, this swelling increases intracranial pressure
(ICP). It is this increase in pressure which leads to the first observable symptoms of water intoxication: headache, personality changes, changes in behavior, confusion, irritability, and drowsiness. These are sometimes followed by difficulty breathing during exertion, muscle weakness, twitching, or cramping, nausea, vomiting, thirst, and a dulled ability to perceive and interpret sensory information. As the condition persists papillary and vital signs may result including bradycardia
and widened pulse pressure
. The cells in the brain may swell to the point where blood flow is interrupted resulting in cerebral edema
. Swollen brain cells may also apply pressure to the brain
stem causing central nervous system dysfunction. Both cerebral edema and interference with the central nervous system are dangerous and could result in seizures, brain damage, coma or death.
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 suspect water intoxication immediately when runners collapse or show signs of confusion.
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 the care-takers might misinterpret the hyponatremic symptoms.
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. Patients with diabetes insipidus are particularly vulnerable due to rapid fluid processing.
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
functions that results when the normal balance of electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s in the body is pushed outside of safe limits by over-consumption of water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
.
Under normal circumstances, accidentally consuming too much water is exceptionally rare. Nearly all deaths related to water intoxication in normal individuals have resulted either from water drinking contests in which individuals attempt to consume large amounts of water, or long bouts of intensive exercise during which electrolytes are not properly replenished, yet excessive amounts of fluid are still consumed.
Water can be considered a poison
Poison
In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....
when over-consumed just like any other substance in a specific period of time. Water intoxication mostly occurs when water is being consumed at a high quantity without giving the body its proper nutrients it needs to be healthy.
Physiology
At the onset of this condition, fluid outside the cells has an excessively low amount of solutes (such as sodiumHyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
and other electrolytes) in comparison to that inside the cells causing the fluid to shift through ( via osmosis
Osmosis
Osmosis is the movement of solvent molecules through a selectively permeable membrane into a region of higher solute concentration, aiming to equalize the solute concentrations on the two sides...
) into the cells to balance its concentration. This causes the cells to swell. In the brain, this swelling increases intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...
(ICP). It is this increase in pressure which leads to the first observable symptoms of water intoxication: headache, personality changes, changes in behavior, confusion, irritability, and drowsiness. These are sometimes followed by difficulty breathing during exertion, muscle weakness, twitching, or cramping, nausea, vomiting, thirst, and a dulled ability to perceive and interpret sensory information. As the condition persists papillary and vital signs may result including bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...
and widened pulse pressure
Pulse pressure
Pulse Pressure is most easily defined as being the amount of pressure required to create the feeling of a pulse. Measured in millimeters of mercury , the pressure difference between the systolic and diastolic pressures give you the amount of pressure change to create the pulse, which is the pulse...
. The cells in the brain may swell to the point where blood flow is interrupted resulting in cerebral edema
Cerebral edema
Cerebral edema or cerebral œdema is an excess accumulation of water in the intracellular or extracellular spaces of the brain.-Vasogenic:Due to a breakdown of tight endothelial junctions which make up the blood-brain barrier...
. Swollen brain cells may also apply pressure to the brain
Brain herniation
Brain herniation, also known as cistern obliteration, is a deadly side effect of very high intracranial pressure that occurs when the brain shifts across structures within the skull...
stem causing central nervous system dysfunction. Both cerebral edema and interference with the central nervous system are dangerous and could result in seizures, brain damage, coma or death.
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.Endurance sports
MarathonMarathon
The marathon is a long-distance running event with an official distance of 42.195 kilometres , that is usually run as a road race...
runners
Running
Running is a means of terrestrial locomotion allowing humans and other animals to move rapidly on foot. It is simply defined in athletics terms as a gait in which at regular points during the running cycle both feet are off the ground...
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
Hyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
. Medical personnel at marathon events are trained to suspect water intoxication immediately when runners collapse or show signs of confusion.
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 – this is compounded by Ecstasy use increasing the levels of antidiuretic hormone (ADH), decreasing the amount of water lost through urination. 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.Psychiatric conditions
Psychogenic polydipsiaPsychogenic polydipsia
Primary polydipsia or psychogenic polydipsia is a special form of polydipsia. It is usually associated with a patient's increasing fluid intake due to the sensation of having a dry mouth....
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 the care-takers might misinterpret the hyponatremic symptoms.
Iatrogenic
When an unconscious person is being fed intravenously (for example, total parenteral nutritionTotal parenteral nutrition
Parenteral nutrition is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals...
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
Hypernatremia
Hypernatremia or hypernatraemia is an electrolyte disturbance that is defined by an elevated sodium level in the blood. Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body...
or hyponatremia
Hyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
may result.
Some neurological/psychiatric medications (Oxcarbazepine
Oxcarbazepine
Oxcarbazepine is a anticholinergic anticonvulsant and mood stabilizing drug, used primarily in the treatment of epilepsy. It is also used to treat anxiety and mood disorders, and benign motor tics...
, among others) have been found to cause hyponatremia
Hyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
in some patients. Patients with diabetes insipidus are particularly vulnerable due to rapid fluid processing.
Prevention
Water intoxication can be prevented if a person's intake of water does not grossly exceed his or her losses. Healthy kidneys are able to excrete approximately 1 litre of fluid water (0.26 gallons) per hour. However, stress (from prolonged physical exertion), as well as disease states, can greatly reduce this amount.Treatment
Mild intoxication may remain asymptomatic and require only fluid restriction. In more severe cases, treatment consists of:- DiureticDiureticA diuretic provides a means of forced diuresis which elevates the rate of urination. There are several categories of diuretics. All diuretics increase the excretion of water from bodies, although each class does so in a distinct way.- Medical uses :...
s to increase urination, which are most effective for excess blood volume. - Vasopressin receptor antagonistVasopressin receptor antagonistA vasopressin receptor antagonist is an agent which interferes with action at the vasopressin receptors. They can be used in the treatment of hyponatremia, especially in patients with congestive heart failure or liver cirrhosis.-Tetracyclines:...
s
Notable cases
- Leah BettsLeah BettsLeah Sarah Betts was a schoolgirl from Latchingdon in Essex, England, United Kingdom. She is notable for the extensive media coverage and moral panic that followed her death several days after her 18th birthday. On 11 November, she took an Ecstasy tablet, and then drank approximately 7 litres of...
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. - On September 12, 1999, US Air ForceUnited States Air ForceThe United States Air Force is the aerial warfare service branch of the United States Armed Forces and one of the American uniformed services. Initially part of the United States Army, the USAF was formed as a separate branch of the military on September 18, 1947 under the National Security Act of...
basic traineeRecruit trainingRecruit training, more commonly known as Basic Training and colloquially called Boot Camp, is the initial indoctrination and instruction given to new military personnel, enlisted and officer...
Michael J. Schindler died of heat strokeHyperthermiaHyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate...
, severely complicated by water intoxication, two days after becoming seriously ill during a 5.8 miles (9.3 km) march. The Air Force changed its recruit training procedures as a result. - On June 9, 2002, 4-year-old Cassandra Killpack of SpringvilleSpringville, UtahSpringville is a city in Utah County, Utah, United States. It is part of the Provo–Orem, Utah Metropolitan Statistical Area. The population was 20,424 at the 2000 census, while the 2008 estimates placed it at 28,520. Just minutes south of Provo, Springville is a bedroom community for...
, UtahUtahUtah is a state in the Western United States. It was the 45th state to join the Union, on January 4, 1896. Approximately 80% of Utah's 2,763,885 people live along the Wasatch Front, centering on Salt Lake City. This leaves vast expanses of the state nearly uninhabited, making the population the...
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 mother, Jennette Killpack, was convicted in 2005 of child abuse homicide. - On October 12, 2002, 3-year-old Rosita Gonzalez of Hollywood, FloridaHollywood, Florida-Demographics:As of 2000, there were 59,673 households out of which 24.9% had children under the age of 18 living with them, 41.5% were married couples living together, 11.9% had a female householder with no husband present, and 42.2% were non-families. 34.4% of all households were made up of...
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. Gayoso was arrested and charged with murder in the first degree on March 10, 2003. After being declared incompetent to stand trial in 2004 and 2005, 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 alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
during a 10-day initiation and hazingHazingHazing is a term used to describe various ritual and other activities involving harassment, abuse or humiliation used as a way of initiating a person into a group....
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." - In a much-publicized case of fraternityFraternities and sororitiesFraternities and sororities are fraternal social organizations for undergraduate students. In Latin, the term refers mainly to such organizations at colleges and universities in the United States, although it is also applied to analogous European groups also known as corporations...
hazingHazingHazing is a term used to describe various ritual and other activities involving harassment, abuse or humiliation used as a way of initiating a person into a group....
, four members of the Chi TauChi TauChi Tau was a local fraternity at Chico State University that landed in the media spotlight following the 2005 hazing death of Matthew Carrington.-Fraternity history:The Delta Alpha Chapter of Delta Sigma Phi was installed at Chico State in the 1950s...
House at California State University, ChicoCalifornia State University, ChicoCalifornia State University, Chico is the second-oldest campus in the twenty-three-campus California State University system. It is located in Chico, California, about ninety miles north of Sacramento...
pleaded guilty to forcing 21-year-old student Matthew CarringtonMatt's LawMatt's Law is a California law that allows for felony prosecutions when serious injuries or deaths result from hazing rites. The bill amended the California Education Code and California Penal Code to change charges for some hazing rituals from misdemeanors to felonies, and for the first time gave...
to drink excessive amounts of water while performing calisthenicsCalisthenicsCalisthenics are a form of aerobic exercise consisting of a variety of simple, often rhythmical, movements, generally using multiple equipment or apparatus. They are intended to increase body strength and flexibility with movements such as bending, jumping, swinging, twisting or kicking, using...
in a frigid basement as part of initiation rites on February 2, 2005. 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 CordovaRancho Cordova, CaliforniaRancho Cordova is a city in Sacramento County, California, USA, that incorporated in 2003. It is part of the Sacramento Metropolitan Area. The population was 64,776 at the 2010 census. Rancho Cordova is the Sacramento area's largest employment sub-center, with a daily influx of over 45,000...
, California, was found dead in her home by her mother, hours after trying to win one of NintendoNintendois a multinational corporation located in Kyoto, Japan. Founded on September 23, 1889 by Fusajiro Yamauchi, it produced handmade hanafuda cards. By 1963, the company had tried several small niche businesses, such as a cab company and a love hotel....
's WiiWiiThe Wii is a home video game console released by Nintendo on November 19, 2006. As a seventh-generation console, the Wii primarily competes with Microsoft's Xbox 360 and Sony's PlayStation 3. Nintendo states that its console targets a broader demographic than that of the two others...
game consoles. KDND 107.9KDNDKDND is an FM radio station licensed to Sacramento, California at 107.9 MHz. It is owned by Entercom. KDND broadcasts a Pop Contemporary Hits format under the name 107.9 The End...
"The End" radio stationRadio stationRadio broadcasting is a one-way wireless transmission over radio waves intended to reach a wide audience. Stations can be linked in radio networks to broadcast a common radio format, either in broadcast syndication or simulcast or both...
's "Hold Your Wee for a Wii" contest, involved drinking large quantities of water without urinatingUrinationUrination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
. A nurse called the radio station to warn them about the danger in which they were putting people, but the disc jockeys were less than impressed. Lucy Davidson, the winner of the contest, was severely sickened while picking up her prize. Civil charges against the radio station were filed by Jennifer's family, and the family was eventually awarded $16.5 million in the ensuing wrongful death lawsuit. The FCCFederal Communications CommissionThe Federal Communications Commission is an independent agency of the United States government, created, Congressional statute , and with the majority of its commissioners appointed by the current President. The FCC works towards six goals in the areas of broadband, competition, the spectrum, the...
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 liters of water in under two hours as part of her LighterLife diet plan.
- Other notable fatalities due to water intoxication include Australian schoolgirl Anna Wood (although similar to Leah Betts, her death was incorrectly atrributed to ecstasy use), 2002 Boston MarathonBoston MarathonThe Boston Marathon is an annual marathon hosted by the U.S. city of Boston, Massachusetts, on Patriots' Day, the third Monday of April. Begun in 1897 and inspired by the success of the first modern-day marathon competition in the 1896 Summer Olympics, the Boston Marathon is the world's oldest...
competitor Cynthia Lucero, and Washington, D.C.Washington, D.C.Washington, D.C., formally the District of Columbia and commonly referred to as Washington, "the District", or simply D.C., is the capital of the United States. On July 16, 1790, the United States Congress approved the creation of a permanent national capital as permitted by the U.S. Constitution....
police officer James McBride. - British actor Anthony AndrewsAnthony Andrews-Life and career:Andrews was born in London, the son of Geraldine Agnes , a dancer, and Stanley Thomas Andrews, a musical arranger and musical conductor. He grew up in the North Finchley district of London...
survived a case of water intoxication in 2003. He was performing as Henry Higgins in a revival of the musical My Fair LadyMy Fair LadyMy Fair Lady is a musical based upon George Bernard Shaw's Pygmalion and with book and lyrics by Alan Jay Lerner and music by Frederick Loewe...
at the time, and consumed up to eight litres of water a day. He was unconscious and in intensive care for three days.
See also
- ElectrolyteElectrolyteIn chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s - DehydrationDehydrationIn physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
- HyponatremiaHyponatremiaHyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...
- HypernatremiaHypernatremiaHypernatremia or hypernatraemia is an electrolyte disturbance that is defined by an elevated sodium level in the blood. Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body...
- GastroenteritisGastroenteritisGastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
- Oral rehydration therapyOral rehydration therapyOral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...
- PolydipsiaPolydipsiaPolydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα...
- Water urticaria
- Dihydrogen monoxide hoaxDihydrogen monoxide hoaxIn the dihydrogen monoxide hoax, water is called by an unfamiliar name, "dihydrogen monoxide", followed by a listing of real negative effects of this chemical, in an attempt to convince people that it should be carefully regulated, labeled as hazardous, or banned...
- Electrolyte imbalance
- List of unusual deaths