Self-induced Water Intoxication Research Articles

Life threatening water intoxication

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.

Role of Naltrexone in Improving Compulsive Drinking in Psychogenic Polydipsia.

Psychogenic polydipsia or self-induced water intoxication is a potentially lethal condition seen in many chronic psychiatric patients. This is a literature review based on therapeutic significance of Naltrexone in improving compulsive water drinking behavior in chronic psychiatrically ill patients with psychogenic polydipsia. Naltrexone is an opioid antagonist approved by FDA for alcohol dependence. Extensive literature search provides a line of evidence that suggests correlation of opioid receptor with compulsive water ingestion in animals. However, there is limited data regarding clinical utility of naltrexone in improving psychogenic polydipsia in human species. This review highlights the necessity for further research and trials to elucidate the role of naltrexone in human psychogenic drinking behavior.

Identification of primary polydipsia in a severe and persistent mental illness outpatient population: A prospective observational study

Studies to date have only investigated primary polydipsia in hospitalized psychiatric patient populations, where rates range from 3% to 25%. The objective of the present study was to determine the occurrence of primary polydipsia in a psychiatric outpatient population, and to determine the perceptions of outpatients with self-induced water intoxication regarding reasons for drinking excess fluids, health risks, and insight into their behavior. All 115 psychiatric outpatients from a Community Outreach Program in Kingston, Ontario, were invited to participate in this study. Of these, 89 (77.4%) were enrolled. Data collection included chart reviews, structured interviews, weight measurements, and urine collection. The incidence of primary polydipsia was found to be 15.7%. One-half of the polydipsic people presenting with medical complications suggestive for water intoxication had cigarette smoking as a strong correlate. There were interesting answers to the self-induced water intoxication questionnaire. These showed a lack of knowledge related to the normal quantity of fluids necessary daily and about healthy behaviors. Excessive drinking occurs in psychiatric patient populations outside of institutional/hospital settings. Patients have limited awareness of the severity and possible complications from their problem. Given the prevalence of polydipsia, more effort should be put into identifying and treating this problem.

Acute Pulmonary Edema Due to Excessive Water Intake in Pyschiatric Patient

Water taking diseases are frequent in psychiatric patient. Approximately 3-6% of psychiatric patient water intoxication is seen. Although water intoxication is defined well, the metabolism of this is not understood. In psychiatric patients, headache, ataxia, confusion, urinary incontinence and electrolyte imbalance is reported. If not treated, confusion, acute delirium, coma and death is seen. Cerebellar edema, pulmonary edema, electrolyte imbalance and urinary incontinence due to water intoxication are reported (1). In this case diagnosis and treatment of psychiatric patient that take excessive water is discussed. The patient a 50-year-old woman schizophrenic had been drinking large amounts of water for several hours before and rapid onset respiratory distress and confusion. In history she started to have fear and stress before 6 years. These symptoms began to increase progressively and last year agitation also seen. Respiratory distress began due to water intake above 10 liters. She was confused, dispneic on admission. TA: 160/90 mmHg, pulse rate 90, respiration 26/min. Cardiovascular and neurologic system was normal and rales were heard in both lungs. In laboratory: Glucose: 100, BUN: 7, Creatinine: 0.8, Na: 129, CI: 87, K: 4.2, albumin:4.1, WBC:8000, Hb:12.2, platelet:367000. Blood gas analysis: Ph 7.32, Pco2 55 mmHg, po2 134 mmHg, Bicarbonate; 36.1 and O2Sat: 99.4. His chest X-ray showed bilateral patch consolidation of the lung fields, cardiomegaly was not seen. Echocardiography; ejection fraction 60 % and no failure. These were suggesting non –cardiogenic pulmonary edema due to excessive water intake and treatment started in our emergency department. 5-ml/min oxygen was given, 3 mg intravenous morphine was done and 5-mcg/kg/min nitroglycerin infusion started, 400 mg intravenous furosemide in 12 hours was given. Patient urinate 3500 cc totally in 12 hours.The clinical outcome was favourable after the treatment. She became alert and ralles decreased. After 24 hours all vital symptoms became stable and patient discharged. Water intoxication is reported in marathon runners, psychiatric patients and soldiers. Psychos, psycotrop drugs, diuretics, nicotine and alcohol can cause excessive water intake. Pyschogenic water intoxication is discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses (2). In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation.. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (3). In our case excessive water intake was due to schizophrenic condition. Pulmonary edema is a rare complication of water intoxication in a psychiatric patient.The physiology of pulmonary edema caused by excessive water intake can’t be explained. Furosemide and water restriction in these patients give good response (2). In our case, echo was normal, bilateral rales were heard and bilateral opacity was seen, these suggested is non –cardiogenic pulmonary edema.

Self-Induced Water Intoxication in a Psychiatric Asylum: A Case Study of Diagnostic Categorization and Regulation

In this article, we examine the regulation of psychiatric patients becoming intoxicated from drinking excessive amounts of liquids at a large psychiatric asylum in Canada. We analyze how medical staff created a formalized diagnostic category and a specialized ward for its treatment. We consider the institutional context in which “water intoxication” was developed as a diagnostic category and we examine the impact of this diagnosis on the regulation of asylum patients. Finally, we discuss the patients’ opposition to treatment as well as the impact of “water intoxication” on their self-identity and institutional status.

Dental hyponatraemia

A 14-year-old girl developed dental pain and was treated for acute infected pulpitis of her right upper lateral incisor with drilling and filling. The pain continued and was helped by analgesia, sucking ice cubes and drinking cold water. Forty-eight hours later, she became confused and disoriented. She started to vomit and complained of headache. Investigations revealed hyponatraemia with normal serum potassium levels and initially normal urinary sodium excretion. Over the next 24 hours, she passed 5.45 L of urine and her serum sodium rose from 125 to 143 mmol/L. Self-induced water intoxication has been described during drinking games and initiation ceremonies, but this would appear to an unusual cause. Conservative management proved successful in allowing this girl to recover without sequelae.

Hypotone Hyperhydratation

BackgroundThe causes of water intoxication are manifold. Isolated case reports of fatal water intoxication have been described in the literature.Materials and methodsA case of self-induced fatal water intoxication in a female psychiatric patient is presented. The results of a search in PubMed for fatal cases of water intoxication from 1995 to 2009 were evaluated and are presented here.ResultsNo age or gender-related differences regarding frequency of occurrence could be found. The most common form was self-induced water intoxication in psychiatric patients. Clinical symptoms of water intoxication are hyponatremia, unconsciousness/coma, seizures and gastrointestinal symptoms. The period of survival after water intake varied between hours and several days. Autopsy findings included brain and lung edema as well as pleural effusions.ConclusionFatal water intoxication constitutes only a minor proportion of forensic autopsies. If water intoxication is suspected, autopsy findings as well as clinical records and laboratory results should be taken into account.

The Treatment of Hyponatremia

Virtually all investigators now agree that self-induced water intoxication, symptomatic hospital-acquired hyponatremia, and hyponatremia associated with intracranial pathology are true emergencies that demand prompt and definitive intervention with hypertonic saline. A 4- to 6-mmol/L increase in serum sodium concentration is adequate in the most seriously ill patients and this is best achieved with bolus infusions of 3% saline. Virtually all investigators now agree that overcorrection of hyponatremia (which we define as 10 mmol/L in 24 hours, 18 mmol/L in 48 hours, and 20 mmol/L in 72 hours) risks iatrogenic brain damage. Appropriate therapy should keep the patient safe from serious complications of hyponatremia while staying well clear of correction rates that risk iatrogenic injury. Accordingly, we suggest therapeutic goals of 6 to 8 mmol/L in 24 hours, 12 to 14 mmol/L in 48 hours, and 14 to 16 mmol/L in 72 hours. Inadvertent overcorrection owing to a water diuresis may complicate any form of therapy, including the newly available vasopressin antagonists. Frequent monitoring of the serum sodium concentration and urine output are mandatory. Administration of desmopressin to terminate an unwanted water diuresis is an effective strategy to avoid or reverse overcorrection.

Risk Factors for Rhabdomyolysis in Self-Induced Water Intoxication (SIWI) Patients

Self-induced water intoxication (SIWI) patients present with various neurological and non-neurological symptoms. However, it is reported that non-neurological manifestations such as rhabdomyolysis are comparatively rare. The mechanism underlying rhabdomyolysis remains controversial. To investigate this further, we evaluated 22 SIWI patients for rhabdomyolysis. We reviewed the records of 22 patients with SIWI and evaluated their clinical characteristics. These patients were divided into the following two groups: Group A with rhabdomyolysis and Group B without it. We compared these groups to study the risk factors underlying the occurrence of rhabdomyolysis. Furthermore, we compared the complications and the duration of hospitalization between the two groups. The maximum serum sodium correction speed per hour, the increase in the serum sodium level in the initial 24 h, and the duration of hospitalization for group A were faster, higher, and longer, respectively, when compared with those in group B. Only group A patients showed complications. The rapid correction of hyponatremia may possibly trigger rhabdomyolysis in SIWI patients.

Recurrent rhabdomyolysis associated with polydipsia-induced hyponatremia — a case report and review of the literature

Rhabdomyolysis involves the breakdown of muscle due to an inciting insult. It has been reported to have many etiologies. Some of the more common causes are trauma and medications. Therapy involves vigorous hydration with a crystalloid or bicarbonate infusion and aims to prevent renal failure caused by the release of myoglobin. This case report describes a patient with a recurrent episode of rhabdomyolysis associated with self-induced water intoxication. He was initially treated with a 3.0% saline infusion, followed by a sodium bicarbonate infusion, with correction of his electrolytes and resolution of the rhabdomyolysis.

Experience of the Community-Residing Individual with Self-Induced Water Intoxication and the Family/Caregiver

BACKGROUND: With long-term psychiatric hospitals closing, the severely mentally ill with self-induced water intoxication (SIWI) are residing in the community. Knowledge about the experience of the community-residing individuals with SIWI and their family/caregiver is needed to develop community programs of care.OBJECTIVES: The purpose of this multi-site study was to understand the experience of the community-residing individual with SIWI and of the family.STUDY DESIGN: Thirty community-residing individuals with SIWI and at least one of their family members/caregivers were interviewed. Semi-structured open-ended questions were used. Urine specific gravity testing was conducted to assure that the individual met the criteria of SIWI.RESULTS: Individuals reported that they felt better when they drank excess fluids, experienced anger when they drank, and believed that staying busy through work helped them control excess drinking. Individuals with SIWI and their families experienced negative feelings including fear of harm and helplessness and distanced themselves from the individual. Families agreed that distress triggered excess fluid drinking. Families also identified boredom as a trigger and felt helpless in being able to help the individual decrease fluid drinking.CONCLUSIONS: Excess fluid drinking is viewed as beneficial by individuals with SIWI, is triggered by distress and boredom, and creates fear and distancing when the family feels threatened by the intoxicated individual. Distress and boredom reduction need to be addressed in programs of care before the community-residing individual with SIWI will be motivated to participate in fluid management.

The relationship between self-induced water intoxication and severity of psychiatric symptoms

The purpose of this study was to test a theoretical framework that proposed a relationship between severe psychiatric symptoms and self-induced water intoxication (SIWI) by using reliable and valid measures. Twenty of 28 community-dwelling individuals with severe mental illness (SMI) in the sample exhibited excess fluid consumption as reflected by a mean urine specific gravity of 1.003 mEq/L. The psychometric measures included the Positive and Negative Syndrome Scale (PANSS), the Self Deficit Syndrome Scale (SDSS), and the Spielberger State-trait Anxiety Scale (STAI From X-1). A significant relationship was found at p .01 between severity of psychotic symptoms and severity of SIWI and between severity of SIWI and psychopathology symptoms within the PANSS. Anxiety was higher in those with SIWI before fluid loading compared with those with less excess fluid intake (i.e., USG < 1.010), and anxiety decreased from morning to evening in those with SIWI compared with those who did not exhibit excess fluid intake. The findings revealed a strong relationship between SIWI and severe psychiatric symptoms, including psychosis and a broad range of psychiatric symptoms. The findings provided initial support for the proposed theory, and consideration needs to be given to the development of interventions to augment existing treatment of fluid control.

Effects of risperidone on polydipsia and self-induced water intoxication

S: The 7th Annual Meeting of the Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan, 20–21 November 1997: PDF Only

Self-induced water intoxication treated with risperidone.

To determine whether or not risperidone is efficacious in treating self-induced water intoxication in patients with chronic schizophrenia. We carried out a prospective 11-month open-label study using risperidone to treat 8 men with chronic schizophrenia and self-induced water intoxication. The 8 men were not able to reduce their fluid consumption compared with their baseline intake. Risperidone, however, significantly decreased the Brief Psychiatric Rating Scale (BPRS) scores of this very chronic group. Although risperidone decreased schizophrenic symptoms, it did not have significant efficacy in treating self-induced water intoxication. This study may have implications for the treatment of addictive behaviour.

Involvement of the Endogenous Opioid System in the Drinking Behavior of Schizophrenic Patients Displaying Self-Induced Water Intoxication: A Double-Blind Controlled Study with Naloxone

Previously we found significant suppression of polydipsia in a schizophrenic patient with PIP syndrome (psychosis, intermittent hyponatremia, and polydipsia). Suppression was obtained with a small dose of naloxone injected once every 2 weeks in long-term repeated studies. We attempted to confirm the effect of naloxone on PIP syndrome by using a double-blind controlled study. The body weights of eight schizophrenic inpatients with PIP syndrome were checked five times daily, and the maximum weight gain during 1 day was chosen as an index of their polydipsia. Naloxone (0.6 mg in three divided doses) or placebo (saline) injection was given once every 2 weeks three times. Assignment to either the naloxone or placebo series was done randomly in a double-blind, crossover design. Naloxone decreased the maximum weight gain per day significantly in five cases. However, naloxone also increased weight gain significantly in three cases. There was no correlation of the weight-increasing effect of naloxone with the duration and intensity of excessive drinking. Our findings showed that the endogenous opioid system might be related to compulsive drinking behavior in the PIP syndrome and that opioid antagonists such as naloxone or naltrexone could be useful in the therapy of PIP syndrome.

Patient perceptions of self-induced water intoxication

This study comprehensively examines self-induced water intoxication (SIWI) from a patient perspective including demographics, reasons for seeking fluids, patterns/behaviors of fluid seeking, and symptoms frequently experienced while in a state of SIWI. The subjects were 45 of an original convenience sample of 62 individuals with a serious mental illness (SMI), hospitalized in a long-term state psychiatric facility, who engaged in self-induced water intoxication. All participants were interviewed in a structured format to complete a 40-item Likert-type questionnaire developed for the study, titled the Self-induced Water Intoxication Questionnaire (SIWIQ). In the study, the majority of participants were smokers, and reported no past problem with alcohol. SIWI occurred more in males than females, and was more predominant in those participants who had longer hospital stays. Anger and vomiting were found to be the two most predominant symptoms experienced when excess fluid consumption occurred. Behaviors of drinking from the shower, the toilet, and one's own urine are consistent with findings of previous studies and illustrate the difficulty in keeping individuals with SIWI from fluids. Data show that participants with SIWI experience considerable anxiety and cognitive difficulties and express these as reasons for engaging in excess fluid consumption. Boredom, obtaining a high, and sad mood were also predominant reasons identified for excess fluid drinking. Significant relationships were found and discussed. The findings provide support for the position that SIWI represents an attempt at treatment by the dysfunctional individual and is pursued for anxiolytic effects and alleviation of boredom. The data support the idea of approaching the problem from a dysfunctional coping framework, realizing that SIWI is a very complex problem, needing examination and intervention at multiple levels, beyond exclusive focus on fluid control.

Serum sodium stabilizing effect of enalapril after standard water load in a patient with a history of self-induced water intoxication

1. 1. A 21 day prospective placebo controlled double blind cross over trial of enalapril was studied in a normonatremic patient with a known history of SIWI. 2. 2. At the end of each prophylactic treatment, the patient was challenged with a water load of 20 ml/kg. 3. 3. The mean serum sodium of 140.111 mmol/L on prophylactic enalapril was significantly higher than the 137.6 mmol/L on placebo (p = 0.0015). 4. 4. After a water load, the mean serum sodium on enalpril was 137.6 mmol/L, compared to 133.833 mmol/L (p = 0.0015) on placebo.

Polydipsia, Hyponatremia, and Water Intoxication Among Psychiatric Patients

Many psychiatric patients suffer from excessive water intake, leading to hyponatremia-lower than norma! concentrations of plasma sodium-and water intoxication, a neurologic syndrome characterized by headaches, ataxia, lethargy, confusion, slurred speech, tremors, restlessness, urinary incontinence, and, in more serious cases, by focal and generalized seizures, stupor, coma, and death. Some of the diagnostic terms applied to these disorders of water intake are compulsive polydipsia, primary polydipsia, and self-induced water intoxication. An accurate diagnosis requires careful psychiatric and neuroendocrine evaluation (1). Reported rates of polydipsia among hospitalized psychiatric patients range between 6 and 17.5 percent, differing by type of institution and case-finding method (2-4). About half of these patients develop water intoxication. A mortality rate as high as 18.5 percent due to complications of water intoxication has been reported (5). About 80 percent of psychiatric patients with polydipsia and water intoxication have a diagnosis of schizophrenia. Other diagnoses asso-

Naloxone attenuates drinking behavior in psychiatric patients displaying self-induced water intoxication

Nishikawa, Tadashi, Akira Tsuda, Masatoshi Tanaka, Mariko Nishikawa, Itsuyuki Koga and Yasunori Uchida: Naloxone Attenuates Drinking Behavior in Psychiatric Patients Displaying Self-induced Water Intoxication. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1994, 18(1): 149–153. 1. 1. The present study was performed to examine the effect of naloxone on drinking behavior in three schizophrenic inpatients with psychosis, intermittent hyponatremia, and polydipsia. 2. 2. Their body weight were checked five times daily and the maximum weight gain during a day was chosen as an index of their polydipsia. 3. 3. After control recording for six weeks, a daily naloxone (0.6 mg) injection series was performed once every two weeks for three series (six weeks). Withdrawal of this drug for six weeks resulted in weight gain recovering to control level. 4. 4. The present study showed that naloxone seems to be a potential treatment for psychiatric patients displayking self-induced water intoxication and that endogenous opioid systems are involved in the compulsive drinking behavior of this syndrome.

Self-induced water intoxication in mental patients.

Research on self-induced water intoxication in mental patients, although limited, is reviewed and invites investigation of causes, relation to psychotropic drugs, and effective treatment procedures.