High risk factors
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 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.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
Marathon runners are susceptible to water intoxication if they drink too much while running. Caused when sodium levels drop below 135mmol/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.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). 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. 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. 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.
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 neurologic/psychiatric medications (Trileptal, among others) have been found to cause hyponatremia in some patients. 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:- Diuretics to increase urination, which are most effective for excess blood volume
- Saline given intravenously to restore sodium electrolyte levels
- Vasopressin receptor antagonists
Prevention
Water intoxication can be prevented if a person's intake of water and electrolytes closely matches his or her losses. 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. 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. 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. 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
- 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 in KDND 107.9 "The End" radio station's "Hold Your Wee for a Wii" contest, which involved drinking large quantities of water without urinating. Because of the name of the contest, some believe that not urinating is related to hyponatremia (a condition related to water intoxication). This is untrue; this type of water intoxication is caused by excessive and rapid consumption of (sodium-free) water. No criminal charges were pressed. The FCC has launched its own investigation to determine if the station violated the terms of its operating license.
- On October 12 2002, 3-year-old Rosita Gonzalez 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 charged and arrested for 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.
- 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 of water in a short period while being disciplined. Her parents, Richard and Jennette Killpack, were convicted in 2005 of child abuse homicide.
- Leah Betts died on the 16th of November 1995 after taking an ecstasy tablet at her 18th birthday party and subsequently drinking too much water.
- In a much-publicized case of fraternity hazing, four members of the Chi Tau (formerly Delta Sigma Phi) 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. He collapsed and died of heart failure due to water intoxication.
- 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. 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.
- 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.
- Other notable fatalities due to water intoxication include Anna Wood, 2002 Boston Marathon competitor Cynthia Lucero, and Washington, D.C. police officer James McBride.
See also
- Electrolytes
- Hyponatremia
- Hypernatremia
- Gastroenteritis
- Oral rehydration therapy
- Polydipsia
- Water urticaria
References
External links
This article is licensed under the GNU Free Documentation License.
Last updated on Sunday October 05, 2008 at 20:11:57 PDT (GMT -0700)
View this article at Wikipedia.org - Edit this article at Wikipedia.org - Donate to the Wikimedia Foundation
High risk factors
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 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.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
Marathon runners are susceptible to water intoxication if they drink too much while running. Caused when sodium levels drop below 135mmol/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.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). 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. 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. 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.
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 neurologic/psychiatric medications (Trileptal, among others) have been found to cause hyponatremia in some patients. 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:- Diuretics to increase urination, which are most effective for excess blood volume
- Saline given intravenously to restore sodium electrolyte levels
- Vasopressin receptor antagonists
Prevention
Water intoxication can be prevented if a person's intake of water and electrolytes closely matches his or her losses. 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. 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. 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. 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
- 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 in KDND 107.9 "The End" radio station's "Hold Your Wee for a Wii" contest, which involved drinking large quantities of water without urinating. Because of the name of the contest, some believe that not urinating is related to hyponatremia (a condition related to water intoxication). This is untrue; this type of water intoxication is caused by excessive and rapid consumption of (sodium-free) water. No criminal charges were pressed. The FCC has launched its own investigation to determine if the station violated the terms of its operating license.
- On October 12 2002, 3-year-old Rosita Gonzalez 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 charged and arrested for 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.
- 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 of water in a short period while being disciplined. Her parents, Richard and Jennette Killpack, were convicted in 2005 of child abuse homicide.
- Leah Betts died on the 16th of November 1995 after taking an ecstasy tablet at her 18th birthday party and subsequently drinking too much water.
- In a much-publicized case of fraternity hazing, four members of the Chi Tau (formerly Delta Sigma Phi) 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. He collapsed and died of heart failure due to water intoxication.
- 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. 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.
- 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.
- Other notable fatalities due to water intoxication include Anna Wood, 2002 Boston Marathon competitor Cynthia Lucero, and Washington, D.C. police officer James McBride.
See also
- Electrolytes
- Hyponatremia
- Hypernatremia
- Gastroenteritis
- Oral rehydration therapy
- Polydipsia
- Water urticaria
References
External links
This article is licensed under the GNU Free Documentation License.
Last updated on Sunday October 05, 2008 at 20:11:57 PDT (GMT -0700)
View this article at Wikipedia.org - Edit this article at Wikipedia.org - Donate to the Wikimedia Foundation
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