Water intoxication

Water intoxication, also known as water poisoning or hyperhydration, is a potentially lethal disturbance in brain function that results from the overconsumption of water. It disturbs electrolyte balance, specifically causing hyponatremia (Hyponatremia), or low sodium concentration in the blood.

Glass-half-full

Pathophysiology

• In a normal state, water and electrolytes are balanced through homeostatic mechanisms involving the kidneys, adrenal glands, and hormones such as vasopressin (antidiuretic hormone). When excessive amounts of water are consumed, the kidneys may be unable to excrete enough fluid. As a result, water levels increase in the blood, diluting the electrolytes, particularly sodium. Sodium plays a crucial role in maintaining the fluid balance both inside and outside cells.
• When sodium concentration drops due to water retention, a condition called hyponatremia ensues. This causes water to move from the extracellular space into cells, leading to cellular edema. Neurons in the brain are particularly affected, leading to potentially life-threatening cerebral edema.

Causes and Risk Factors

• Water intoxication typically results from drinking excessive amounts of water in a short period. It can occur during water drinking contests or high-intensity activities such as marathons, where large volumes of fluid are consumed to counteract dehydration. Certain psychiatric conditions, such as psychogenic polydipsia, also predispose individuals to water intoxication.
• In addition, medical conditions that impair excretion of water can increase the risk of water intoxication. These include kidney disease, heart failure, and certain forms of diabetes.

Clinical Presentation

Symptoms of water intoxication may start with mild headache, nausea, vomiting and changes in mental status such as confusion or disorientation. As the condition progresses, it can lead to muscle weakness, seizures, unconsciousness, and in severe cases, coma or death.

Diagnosis

The diagnosis of water intoxication is based on patient history, clinical presentation, and laboratory findings. Key diagnostic indicators include a history of excessive water intake, symptoms of hyponatremia, and abnormally low sodium levels in the blood.

Treatment

The treatment of water intoxication aims to restore sodium balance in the body. This often involves restricting fluid intake and addressing the underlying cause. In severe cases, intravenous hypertonic saline may be administered to rapidly increase serum sodium levels.

Prognosis and Prevention

• Prompt recognition and treatment of water intoxication generally lead to a favorable prognosis. However, severe cases can be life-threatening, particularly if cerebral edema leads to brain damage.
• Prevention of water intoxication focuses on educating individuals about the dangers of excessive water consumption and promoting healthy hydration habits.

See Also

• Hyponatremia
• Hyperhydration
• Cerebral edema

References

• Hew-Butler, T., Rosner, M. H., Fowkes-Godek, S., Dugas, J. P., Hoffman, M. D., Lewis, D. P., ... & Hoffman, M. D. (2015). Statement of the Third International Exercise-Associated *Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clinical Journal of Sport Medicine, 25(4), 303-320.
• Avis, H. J., Vyth, O. L., Stassen, R. E., & van Veen, T. A. (2020). Systematic review of the mechanism of injury in paediatric washing machine accidents. Injury, 51(1), 15-19.

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