Monday, August 7, 2023

Water toxicity

An Indiana mom of two collapsed and died from water toxicity after drinking too much water in a short period of time, her family says.

Ashley Summers, 35, was near Monticello at Lake Freeman with her husband and two daughters over July 4th weekend when she was hospitalized with brain swelling, Ashley’s brother, Devon Miller, told WRTV.

"Someone said she drank four bottles of water in 20 minutes," Miller said. "I mean, an average water bottle is like 16 ounces, so that was 64 ounces that she drank in a span of 20 minutes. That’s half a gallon. That’s what you’re supposed to drink in a whole day."

The Mayo Clinic says that the daily fluid intake for women should be about 92 ounces, with 20% of daily fluids usually coming from foods.

Summers had said she was feeling dehydrated, lightheaded and had a headache, noting that she felt like she could not drink enough water, her family told the outlet.

The mom of two passed out in a garage and was rushed to a hospital.

Summers, however, never regained consciousness, and doctors said she died of water toxicity, according to the family.

"It was a shock to all of us," Miller said. "When they first started talking about water toxicity. It was like, ‘this is a thing?’"

Hyponatremia, also known as water toxicity, occurs when the concentration of sodium in your blood is abnormally low, according to the Mayo Clinic.

"When this happens, your body's water levels rise, and your cells begin to swell," the clinic says. "This swelling can cause many health problems, from mild to life-threatening."

To prevent hyponatremia, the clinic advises drinking water in moderation and to consider drinking sports beverages that contain electrolytes during endurance activities.

Summers was an organ donor and donated her heart, liver, lungs, kidneys and some of her long bone tissue to help save five other lives, her family said.

Rangan GK, Dorani N, Zhang MM, Abu-Zarour L, Lau HC, Munt A, Chandra AN, Saravanabavan S, Rangan A, Zhang JQJ, Howell M, Wong AT. Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review. BMJ Open. 2021 Dec 9;11(12):e046539. doi: 10.1136/bmjopen-2020-046539. PMID: 34887267; PMCID: PMC8663108.


Introduction: Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.

Methods: This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946-2019) were included.

Results: A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.

Conclusion: Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.

Bafarat AY, Labban SA, Alhatmi N, Aly H, Bashah DM, Alshaiki F. Hyponatremia-Induced Seizure in a Patient With Psychogenic Polydipsia: A Case Report. Cureus. 2023 Apr 17;15(4):e37710. doi: 10.7759/cureus.37710. PMID: 37206512; PMCID: PMC10191386.


Psychogenic polydipsia is a rare condition characterized by overconsumption of water. It can lead to water intoxication, which is potentially a life-threatening situation. Moreover, it usually occurs in patients with mental disorders, mainly schizophrenia. This report discusses a successful treatment of a 16-year-old male with psychogenic polydipsia and delusional disorder presenting to the emergency room with a hyponatremia-induced seizure. After stabilizing the patient, he was referred to a psychologist, and behavioral therapy was conducted. Post-discharge follow-ups revealed that behavioral therapy and the use of self-monitoring technique were effective in controlling the patient's condition. His water intake was reduced from 15 liters per day to three liters per day. This case highlights the importance of psychological assessment for patients with features suggestive of psychogenic polydipsia. It also highlights the need for immediate admission and prompt treatment for such patients as it is a high-risk condition.

No comments:

Post a Comment