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Water intoxication (also known as hyperhydration or water poisoning) is a potentially fatal disturbance in brain function that results when the normal balance of electrolytes in the body is pushed outside of safe limits by water. An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Water is a common Chemical substance that is essential for the survival of all known forms of Life. [1] Normal, healthy (both physically and nutritionally) individuals have little 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 more than ten litres over the course of just a few minutes, or long bouts of intensive exercise during which electrolytes are not properly replenished, yet massive amounts of fluid are still consumed.

Contents

Physiology

Blood contains electrolytes (particularly sodium compounds, such as sodium chloride) in concentrations that must be held within very narrow limits. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Sodium (ˈsoʊdiəm is an element which has the symbol Na( Latin natrium, from Arabic natrun) atomic number 11 atomic mass 22 For sodium chloride in the diet see Salt. Sodium chloride, also known as common salt, table salt, or Halite, is a Water enters the body orally or intravenously and leaves the body primarily in urine, sweat, and water vapor. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. General properties of water vapor Evaporation/sublimation Whenever a water molecule leaves a surface it is said to have evaporated If water enters the body more quickly than it can be removed, body fluids are diluted and a potentially dangerous shift in electrolyte balance occurs. In other words, the body has too much water and not enough electrolytes.

Most water intoxication is caused by hyponatremia, insufficient sodium in the blood plasma, which in turn causes an osmotic shift of water from extracellular fluid (outside of cells) to intracellular fluid (within cells). Hyponatremia ( British: hyponatraemia) is an Electrolyte disturbance (disturbance of the salts in the blood in which the Sodium ( Natrium Osmosis is the Diffusion of a solvent (frequently water through a semi-permeable membrane, from a solution of low solute concentration (high water potential Extracellular fluid (ECF usually denotes all body fluid outside of cells The cytosol or intracellular fluid (or cytoplasmic matrix) is the liquid found inside cells. The cells swell as a result of changes in osmotic pressure and may cease to function. Osmotic pressure is the hydrostatic pressure produced by a difference in concentration between solutions on the two sides of a surface such as a semipermeable membrane When this occurs in the cells of the central nervous system and brain, water intoxication is the result. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Additionally, many other cells in the body may undergo cytolysis, wherein cell membranes that are unable to stand abnormal osmotic pressures rupture, killing the cells. Cytolysis, or osmotic lysis, occurs when a cell bursts due to an osmotic imbalance that has caused excess water to move into the cell The cell membrane (also called the plasma membrane, plasmalemma, or "phospholipid bilayer" is a Selectively permeable Lipid bilayer Initial symptoms typically include light-headedness, sometimes accompanied by nausea, vomiting, headache and/or malaise. Light-headedness is a common and often unpleasant sensation of Dizziness and/or feeling that one may be about to faint, which may be transient recurrent or occasionally Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Malaise is a feeling of general discomfort or uneasiness an "out of sorts" feeling often the first indication of an infection or other disease Sodium levels below 100 mmol/l (2. 3 g/l) frequently result in cerebral edema, seizures, coma, and death within a few hours of drinking the excess water. Cerebral edema (cerebral oedema in British English) is an excess accumulation of water in the intracellular and/or extracellular spaces of the Brain. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. Death is the termination of the biological functions that define living Organisms It refers both to a specific As with alcohol poisoning, the progression from mild to severe symptoms may occur rapidly as the water continues to enter the body from the intestines or intravenously. The short-term effects of alcohol on the human body can take several forms

A person with healthy kidneys can excrete about 900 milliliters per hour (0. The kidneys are complicated organs that have numerous biological roles 24 gal/hr). [2] However, this must be modulated by potential water losses via other routes. For example, a person who is perspiring heavily may lose around 1 litre an hour (0. 26 gal/hr) of water through perspiration alone, thereby raising the amount of water that must be consumed before the individual crosses the threshold for water intoxication. The problem is further complicated by the amount of electrolytes lost in urine or sweat, which is variable within a range controlled by the body's regulatory mechanisms.

Water intoxication can be prevented by consuming water that is isotonic with water losses, but the exact concentration of electrolytes required is difficult to determine and fluctuates over time. Tonicity is a measure of blood capacity or effective osmolality in cell Biology. Over long periods of deficiencies between electrolyte loss and electrolyte intake, a small deficiency may reach the threshold if continued over many hours because of continual negative net electrolyte intake.

Sodium is not the only mineral that can become overdiluted from excessive water intake. Magnesium is also excreted in urine. Magnesium (mægˈniːziəm is a Chemical element with the symbol Mg, Atomic number 12 Atomic weight 24 According to the National Institutes of Health, "magnesium deficiency can cause metabolic changes that may contribute to heart attacks and strokes. "NIH" redirects here For other meanings of NIH see NIH (disambiguation. Magnesium deficiency refers to an absolute lack of Magnesium, the result of numerous conditions Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. "[3] Intravenous magnesium is used in cardiac care units for cardiac arrhythmias. Dysrhythmia redirects here For the American band see Dysrhythmia (band. [4]

High risk factors

Gastroenteritis, particularly in infants and children

The severe diarrhea and vomiting associated with gastroenteritis can result in very large electrolyte losses. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the Gastroenteritis due to infectious agents (primarily rotavirus), is a major cause of infant and child death. A pathogen (from Greek πάθος pathos "suffering passion" and γἰγνομαι (γεν- gignomai (gen- "I give birth to" infectious Rotavirus is a Genus of Double-stranded RNA virus in the family Reoviridae. Management of gastroenteritis requires replacing water and electrolytes in proportions that avoid both dehydration and water intoxication. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Drinking water will replace lost water and avoid 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. Oral rehydration therapy, (also called ORT, oral rehydration salts or solutions (ORS, oral electrolyte) is a simple cheap and effective

Low body mass (infants)

It can be very easy for children under a year old to absorb too much water – especially if the child is under nine months old, because with their small body mass, it is easy to take in a large amount of water relative to body mass. It is also possible for a child to absorb too much water if submerged in it. [5]

Endurance sports

Marathon runners are susceptible to water intoxication if they drink only water while running. The marathon is a long-distance foot race with an official distance of 42 Running is a means for an animal to move on Foot. It is defined in Sporting terms as a Gait in which at some point all feet are off the ground Although sweat is relatively hypotonic compared with body fluids, marathon runners perspire heavily for long periods, potentially causing their sodium levels to drop when they consume large amounts of fluids to quench their thirst. Tonicity is a measure of blood capacity or effective osmolality in cell Biology. The replacement fluids may not contain sufficient sodium to replace what has been lost, and this puts them at high risk for water intoxication. Medical personnel at marathon events are trained to immediately suspect water intoxication 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. Persons 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 (See the case of Leah Betts). MDMA ( 34-methylenedioxy- N -methylamphetamine) most commonly known today by the street name Ecstasy (often abbreviated E, X, Leah Betts ( November 11, 1977 - November 16, 1995) was a schoolgirl from Latchingdon in Essex, England. 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 polydipsia is the psychiatric condition in which patients feel compelled to drink large quantities of water, thus putting them at risk of water intoxication. Psychogenic polydipsia is a special form of Polydipsia, caused by mental disorders 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.

Medical conditions

A great many disorders can affect electrolyte balance, especially disorders of the kidneys. The kidneys are complicated organs that have numerous biological roles 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. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Mineralocorticoids are a class of Steroid hormones characterised by their similarity to Aldosterone and their influence on salt and water balance Diuresis is the increased production of Urine by the Kidney. Types and causes The kidney normally produces up to 180 L of "pro-urine" Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc

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. Total Parenteral nutrition (TPN is the practice of feeding a person Intravenously bypassing the usual process of Eating and Digestion. Nasogastric intubation is a medical process involving the insertion of a plastic tube ( nasogastric tube NG tube) through the Nose, past the Throat These fluids are typically hypertonic, and so water is often co-administered. Tonicity is a measure of blood capacity or effective osmolality in cell Biology. If the electrolytes are not monitored (even in an ambulatory patient) either hypernatremia or hyponatremia may result. Hypernatremia is an Electrolyte disturbance that is defined by an elevated Sodium level in the blood Hyponatremia ( British: hyponatraemia) is an Electrolyte disturbance (disturbance of the salts in the blood in which the Sodium ( Natrium

Some neurologic/psychiatric medications (Trileptal, among others) have been found to cause hyponatremia in some patients. Oxcarbazepine (marketed as Trileptal by Novartis or Trexapin by Taro is an Anticonvulsant and mood stabilizing drug, used primarily Hyponatremia ( British: hyponatraemia) is an Electrolyte disturbance (disturbance of the salts in the blood in which the Sodium ( Natrium Patients with diabetes insipidus are particularly vulnerable due to rapid fluid processing.

Treatment

Mild intoxication may remain asymptomatic and require only fluid restriction. In more severe cases, treatment consists of:

Prevention

Water intoxication can be prevented if a person's intake of water and electrolytes closely matches his or her losses. A diuretic is any Drug that elevates the rate of urination ( Diuresis) In Medicine, saline (also saline solution) is a general term referring to a sterile solution of Sodium chloride (table Salt) in water Sodium (ˈsoʊdiəm is an element which has the symbol Na( Latin natrium, from Arabic natrun) atomic number 11 atomic mass 22 Arginine vasopressin ( AVP) also known as vasopressin, argipressin or antidiuretic hormone ( ADH) is a Hormone found in The body's regulatory mechanisms provide a very generous margin of safety if the two are imbalanced, but some extreme activities (such as heavy, prolonged physical exertion), as well as disease states, can overwhelm or impair these mechanisms. Avoid situations that provoke extreme or prolonged perspiration. Drinking fluids that are specially balanced to replace lost electrolytes can also help to prevent intoxication. Eating regularly can provide needed electrolytes if only normal water is available for rehydration.

Sports drinks are popular among athletes because they provide the necessary electrolytes to support extended exercise. A sports drink is a Beverage designed to help athletes rehydrate as well as replenish Electrolytes Carbohydrates, and other Nutrients An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium They help keep the body balanced and carrying the right amount of fluids. However, not all drinks advertised as sports drinks are suitable for this purpose, and professional advice should be sought for potentially risky situations such as those described above.

Note that a person's innate sense of thirst is more sensitive to overall dehydration than to changes in electrolytes. Thirst is the craving for liquids resulting in the basic Instinct of humans or animals to Drink. Thus, it is possible to develop water intoxication while trying to satisfy thirst, if one drinks a great deal of water over a short period. A dangerous drop in electrolytes, such as the hyponatremia that leads to water intoxication, will not have any effect on thirst if one is sufficiently dehydrated.

For people suffering from dehydration due to the heavy perspiration associated with heavy exertion or heat stress, drinking water to rehydrate is much more important than avoiding water intoxication, since the former is extremely common and the latter is rare. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object One should never avoid drinking water under such conditions; instead, other steps should be taken to ensure that electrolytes are replaced as well, as noted above.

Notable cases

See also

References

  1. ^ Bird, Patrick J. An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Hyponatremia ( British: hyponatraemia) is an Electrolyte disturbance (disturbance of the salts in the blood in which the Sodium ( Natrium Hypernatremia is an Electrolyte disturbance that is defined by an elevated Sodium level in the blood Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the Oral rehydration therapy, (also called ORT, oral rehydration salts or solutions (ORS, oral electrolyte) is a simple cheap and effective Polydipsia is a medical symptom in which the patient drinks abnormally large amounts of Fluids The word derives from the Greek πολυδιψία, the Water urticaria, also known as aquagenic urticaria and aquagenous urticaria, is an extremely rare form of Physical urticaria. (2000). You Can Drink Too Much Water. University of Florida. Retrieved on 2007-01-21. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1189 - Philip II of France and Richard I of England begin to assemble troops to wage the Third Crusade.
  2. ^ Noakes, T. D. ; G. Wilson, D. A. Gray, M. I. Lambert, S. C. Dennis (October 2001). Peak rates of diuresis in healthy humans during oral fluid overload. National Center for Biotechnology Information. Retrieved on 2007-01-21. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1189 - Philip II of France and Richard I of England begin to assemble troops to wage the Third Crusade.
  3. ^ Facts about Dietary Supplements, Office of Dietary Supplements, National Institutes of Health, March 2001.
  4. ^ Jay S. Cohen, MD, Statin Drugs, 2005, page 129, ISBN 0-7570-0257-9. The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower Cholesterol levels in people with or at risk of Cardiovascular
  5. ^ Water Intoxication in Infants
  6. ^ Woman dies after water-drinking contest. MSNBC (January 13, 2007). MSNBC is a 24-hour cable television news channel based in the United States and available in Canada. Events 532 - Nika riots in Constantinople. 888 - Odo Count of Paris becomes King of the Franks Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Retrieved on 2007-05-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1291 - Scottish Nobles recognize the authority of Edward I of England.
  7. ^ Local10.com/WPLG report of water intoxication murder arrest
  8. ^ Sun-Sentinel article: Nancy Gayoso declared competent to stand trial
  9. ^ Local10.com/WPLG report: "Judge: Baby Sitter in Water Intoxication Death Still Not Competent"
  10. ^ Hyponatremia ("Water Intoxication"). The DEA. org. Retrieved on 2007-05-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1291 - Scottish Nobles recognize the authority of Edward I of England.
  11. ^ Lore, Mark (2005-02-10). Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. Events 1355 - The St Scholastica's Day riot breaks out in Oxford, England, leaving 63 scholars and perhaps 30 locals dead Another death in the family. Chico news & review. Retrieved on 2007-05-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1291 - Scottish Nobles recognize the authority of Edward I of England.
  12. ^ Grier, Peter. "Airman's Death Brings Training Changes", Aerospace World, Air Force Magazine Online, January, 2000. Retrieved on 2007-01-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 250 - Emperor Decius begins a widespread persecution of Christians in Rome.  
  13. ^ Reasons for dispensing with the holding of an inquest. Retrieved on 2007-05-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1291 - Scottish Nobles recognize the authority of Edward I of England.
  14. ^ Doctors: Marathoner Died From Too Much Water (August 13, 2002). Events 3114 BC - According to the Lounsbury correlation the start of the Maya calendar. See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. Retrieved on 2007-05-10. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1291 - Scottish Nobles recognize the authority of Edward I of England.
  15. ^ District Officer Dies After Bike Ride: Over-Hydration Cited as Factor.

External links

Dictionary

water intoxication

-noun

  1. A potentially fatal disturbance in brain function that results when the normal balance of electrolytes in the body is pushed outside of safe limits by a very rapid intake of water.
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