Life threatening water intoxication

Shahad W Ahmed

doi:10.30539/ijvm.v44i2.978

Abstract

Water intoxication is a fatal disorder associated with disturbance in brain function, known as hypo-osmolar syndrome which resulting from an excessive water intake, with dilutional hypernatremia leads to a potentially fatal outcome. A change in the electrolyte equilibrium such as this sudden drop in serum sodium level and then subsequent mortality. With hyponatremia, the plasma osmolality decreased leading to water movement into the brain according to the osmotic gradient, resulting in hyponatremic encephalopathy and cerebral oedema. Increased water intake such as in Psychogenic polydipsia is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of water intoxication with headache, blurred vision, nausea, tremor, and deterioration in psychosis. Other serious symptoms involve muscle spasms, Early detection of seizures and coma are more serious outcomes, Untreated cases may lead to death, Risk factor for water intoxication are Marathon runners, military population and athletes and due to this endurance events, these behaviors encouraging heavy sweating that result in heat exhaustion and consume large volumes of fluid, then hyponatremia developed as a result of excessive fluid substitution. Child abuse is other pediatric clinical cases reported with water intoxication. Psychogenic polydipsia which is psychiatric disorder with obsessive water drinking leading to a serious self-induced water intoxication (SIWI), water is normally metabolized and excreted by different means and it is mainly by kidneys in urine, evaporation through the skin, by respiratory system through the respired water vapor and little quantity of water was lost from the gastrointestinal tract (GI).The LD50 of water is > 90 ml/kg orally in rats. The current review illustrates the Life threatening effects of water when it is aggressively consumed.

Highlights

Water toxicity may occur, but it is difficult to diagnose because it presents with symptoms of altered mental status, disorientation , confusion, nausea, and vomiting that may resemble with psychosis, This variability of symptoms it may be misdiagnosed upon presentation, Early detection of seizures are more serious outcomes, untreated Cases may lead to death [7]
Water can be considered as a poison when over consumed within a short period of time without adequate intake of electrolytes [3], and this cause a lethal disorder with disturbance in brain function, known as hypo-osmolar syndrome, with dilutional hyponatremia that caused mainly by water retention exceeding kidney-free water excretion or impaired kidney-free water excretion [4], this condition described as hyperhydration, water toxemia, overhydration or water poisoning, and that will happened when imbalance of electrolytes in the body is occured by excessive water intake, in normal conditions too much water consuming is rare [5], acute hyponatremia can cause cerebral oedema, cerebral hernia, and may lead to death [6]
Marathon runners are susceptible to water poisoning, if they drink too much while running, This is occurred when a decrease in sodium levels is below 135 mmol/ L due to athletes consuming large volumes of fluid, which has been noted as the result of excessive fluid substitution [14], In athletic endurance events and in the military population,exercise-associated hyponatremia (EAH) has been identified [15], military field activities such as load marching and equipment are often practiced in hot and humid climate [16]

Summary

Introduction

Water toxicity may occur, but it is difficult to diagnose because it presents with symptoms of altered mental status, disorientation , confusion, nausea, and vomiting that may resemble with psychosis, This variability of symptoms it may be misdiagnosed upon presentation, Early detection of seizures are more serious outcomes, untreated Cases may lead to death [7].

Results

Conclusion