Water intoxication, at first glance, seems to be a very minor malady but unbeknownst to some, water intoxication, or dilutional hyponatremia, if left untreated can lead to coma, even death. Fatal cases for water intoxication may be rare but ensuring that symptoms are addressed is vital for survival, especially during this time of climate change.
Dilutional hyponatremia is a physiological disturbance brought about by over hydration, or drinking too much fluid at a short amount time resulting to an imbalance of electrolytes and blood sodium in our bodies. Physicians do recommend drinking several glasses of water per day to help maintain good health and prevent disease from taking over but, as the saying goes, too much of a good thing can be dangerous.
What causes this condition
The fluids in our body is controlled through urine and thirst; we feel the latter if our body senses that we don’t have enough fluids running through our body and uses the latter to discharge of any waste processed by our kidneys. Sodium levels in our bloodstream are most affected by these two ways of fluid excretion as sodium helps balance the fluids around our cellular make-up. Without the perceived barrier caused by sodium, fluids moving around our cells are absorbed in, making the cells swell.
Essentially, water intoxication can stem from two types of over hydration: the first one resulting from an increased fluid intake and the second is when our body retains any excess water, which is often tells of a more serious medical condition.
The total amount or volume of water in the body present during the time of intoxication can also act as a basis of identifying which type of water intoxication has affected the patient.
Like many medical conditions, dilutional hyponatremia can be a result of one or more several factors.
- Endurance athletes and outdoorsmen are also prone to water intoxication especially after going through a grueling exercise or extreme outdoor conditions causing them to feel more thirsty and more prone to drinking too much as a result. New athletes are also at risk since they tend to consume more fluids than other, more experienced members of their community.
- Participation in any other non-sporting yet physical activity also increases the chances of water intoxication since the more we sweat, the more we feel thirsty and the more we feel thirsty, the more we feel the urge to drink water. People working under extreme conditions are susceptible to this.
- Some psychiatric conditions, like schizophrenia, often compel the patient to drink more fluids than they normally would.
- Psychological stress brought about by severe emotional problems can also cause compulsive water intake thus increasing the risk of water intoxication among people with high stress levels.
Some medications used to treat anxiety and depression, diarrhea, colds and asthma have a lingering side effect called “dry mouth”. This condition restricts saliva from flowing freely and eventually dries the mouth, making the patient uncomfortable and always thirsty.
- Low body mass also count as a risk factor, especially for infants, as their small bodies would not be able to handle too much water and still retain ample sodium levels.
- Patients who are being fed through a nasogastric tube or intravenously are also susceptible as electrolytes for these cases are not monitored since it is assumed that the fluids are hypertonic, or concentrated in layman’s terms.
Some medical conditions can cause excessive fluid retention.
These conditions include following:
Short for “Syndrome of Inappropriate Anti-Diuretic Hormone”, this condition is often characterized as the abnormal secretion of the posterior pituitary gland of anti-diuretic hormone whose primary function in the human body is to regulate the retention of water by increasing the water reabsorption in collecting ducts within the kidney.
Cirrhosis of the liver is often diagnosed with increased fluid retention or edema. Edema is the swelling of any body part as a result of injury or inflammation and with this condition, small blood vessels leak fluid into nearby tissue causing the tissue to swell since the fluids cannot be reabsorbed directly.
The kidney, being the waste disposal department of our body, is often at risk to infection and diseases, especially if the condition causes the kidney to absorb more fluids than necessary.
Some hormonal diseases like Addison’s and hypothyroidism has been linked with low sodium levels resulting.
- Drugs. The party drug ecstasy, or MDMA, can cause users to heavily overexert themselves and perspire heavily. This would compel them to continuously drink water until they feel relieved. This is compounded by the fact that MDMA can also agitate the anti-diuretic hormone levels in our body, thus preventing any excess water from being released through urine.
- Beer. Alcoholics who consumed bottle upon bottle of beer are also prone to water intoxication. Beer contains a very small amount of sodium and if combined with an unhealthy diet can result to rapid sodium loss resulting in hyponatremia.
Watch the signs
There are several telltale signs to watch out for in detecting water intoxication.
These signs would lead to the symptoms that help in assessing the situation.
- Swelling – a person suffering from water intoxication would sometimes have swollen toes and fingers. The digits will be clammy to the touch and will have a water-balloon like consistency.
- Clear urine – the color of a person will normal fluid levels will range from light yellow to light orange. Clear urine is an indication that you already have consumed too much water and will need to cut back.
- Significant change in body weight – changes in a person’s body weight would often mean the betterment of one’s health but sometimes it can also mean that the body has gained weight due to the volume of fluids coursing through the veins, depositing drops in tissues all over.
- Dry or sweaty skin – a person suffering from water intoxication would sometimes have dry or sweaty skin, this in combination with other symptoms can lead to a diagnoses of water intoxication.
Symptoms of water intoxication
Drinking too many fluids in a short period of time can cause our blood sodium to lower and the resulting imbalance is manifested through the symptoms listed below.
Early stage – water intoxication at this stage cannot easily be detected but early symptoms include:
- Nausea and vomiting – this is often accompanied by dizziness and varying degrees of discomfort around the upper stomach. Mild cases often don’t lead to vomiting.
- Disorientation and confusion – low blood sodium levels will result in low blood volume which directly affects our brain functions.
- Headache – the increase of fluids in the blood cells dilute the plasma and once the diluted blood reaches the brain can cause mild to severe headaches.
- Restlessness – patients suffering from water intoxication will have discomfort, especially when sitting down as the fluids around the cells will accumulate and give the feeling of bloatedness.
- Fatigue – an opposite reaction to the previously discussed, patients with water intoxication would feel an overall sense of weakness, sometimes in conjunction with restlessness.
Advanced stage – left untreated, water intoxication will further affect sodium levels in our blood and manifest itself through:
- Muscle spasms, weakness, and cramps – as the electrolyte levels in our body go down, so does the normal flow of blood going through our muscles and this would cause mild to acute spasms; a sense of weakness when trying to use the muscle; and jolting cramps that can lead to temporary paralysis.
- Slurred speech – another effect of blood not flowing normally, slurring can also manifest itself during the advanced stages of water intoxication.
- Diarrhea – this symptom further pushes the electrolyte imbalance as essential fluids are excreted unnecessarily
- Unconsciousness – advanced stage depletion of blood sodium will lead to loss of consciousness as a result of the body shutting down secondary processes.
- Seizures – the decrease in the quality of blood circulating around the body can cause seizures which can become permanent if not immediately addressed.
Water intoxication should always be tended to within a span of hours, left unattended for more than 1 or 2 days can result in the following complications:
Comatose – patients already unconscious can succumb to coma immediately if the primary cause is not identified and the necessary treatment is not given. Some cases often escalate to comatose in a short span of time.
Organ Damage – once the blood flow is affected, several organs are affected. Some of these will immediately repair themselves after or during treatment while some will have permanent damage.
Diabetes – sodium loss also equal to the depletion of the body’s sugar level and if unaddressed, water intoxication can cause diabetes.
Palsy – as with organ damage, neurological function will also be gravely affected by poor blood quality and unaddressed symptoms.
Retardation – a very rare complication, mental retardation can also result from water intoxication if the condition is severe.
Death – the final complication to every malady. Several cases have already been documented for water intoxication resulting to immediate death. These are mostly caused by torture or hazing.
Similarities with heat exhaustion
The symptoms of water intoxication listed above are similar with those related to heat stroke. Some experts also argue that water intoxication is, in a way, a type of heat illness. Given the fact that the symptoms for water intoxication are the same as heat exhaustion, this makes it hard to determine what exactly has affected the patient. Water intoxication can happen when the temperatures are at the high extremes too.
Heat exhaustion, on the other hand, can also result from the depletion of sodium from body and cause symptoms that are similar to water intoxication. And like water intoxication, heat exhaustion due to low sodium levels can also happen in extreme temperatures.
The similarities with their symptoms hinder proper diagnosis without consulting a trained physician. A battery of laboratory tests is needed to properly determine and diagnose if the patient is suffering one from the other but conducting a brief history of events leading to the moment can help determine if its intoxication or exhaustion.
If a patient qualifies for one or more of the risk factors stated in this article then it is most likely that they have suffered intoxication. There are still some symptoms present in heat exhaustion that does not manifest with water intoxication. These include fainting, pale skin, profuse sweating and a rapid heartbeat.
As the old saying goes, an ounce of prevention is worth a pound of cure. Ample preparation is needed to prevent illnesses like water intoxication from disrupting our day-to-day activities.
Here are some tips in preventing water intoxication:
For randonneurs, tri-athlete, marathon runners and other endurance athletes, the following are applicable:
- Weight in and weight out – make it a habit to weight yourself before pursuing any exhaustive activity. The target is to match the amount of weight loss due to sweat with an equivalent volume of fluid right after the exercise. The rule of thumb for these events is to drink at least 20 ounces of fluids, preferably with electrolytes, within several hours after each training session and, most importantly, after the event.
- Keep drinking tabs – it is important that we keep track of our fluid intake, regardless if it is during training or during the event. Keeping track will help us understand our drinking patterns which, in turn, will help us determine the correct amount of fluid we should take. One important fact to note, sports drinks count as water and should be taken into consideration when tracking fluid intake.
- Eat salt – not literally of course, but a steady intake of salty food while training will keep your sodium levels in check and prevent water retention.
- Rest – beginners should take advantage of any rest stop available. Especially in high temperatures, endurance athletes should take a rest and let cool their body down.
- Sip It – Never gulp down any fluid during or after an exercise, always take fast, short sips to slowly cool down the body and prevent accidental water intoxication. Gulping in too much at a time will prevent the body from absorbing the fluid and will result in excessive water in our system.
For outdoorsmen – outdoorsmen are often the most vulnerable to water intoxication due to the environment they immerse themselves in. Add the fact that the weather in the wilderness is unpredictable.
- Prepare for the worst – basic mountaineering dictates that mountaineers should always be ready for anything that could happen; this includes the sudden onset of disease and injury.
- Plan Ahead – Take into consideration the area you will be trekking into and identify possible water sources and rest stops. Rest stops should have ample tree cover to lessen the chances of thirst and the cool shade will also help regulate the body temperature.
- Trail food – prepare trail food that has a healthy balance of sweet and salty to prevent both low sodium and low sugar levels. A good trail mix will have nuts, some chocolate and beans that will provide small energy boosts along the way.
- Ask the weatherman – before any outdoor excursion, it is always wise to read up on weather situations in the general vicinity. While the weather can become unpredictable, having a general feel of what to expect will help.
- Rehydration salts – a well-prepared outdoorsman will always have a first aid kit and their first aid kit should always have oral rehydration salts that can help water intoxication sufferers recover faster. Check out our top picks for the best safe and affordable hydration drinks for more choices.
Medically at risk
Persons who have existing medical conditions should always consult with their physicians before undertaking any task that will force them to exert more effort than usual. Doctors would often advise against the activity while some will recommend a strategy on how they can overcome the challenge.
Sufferers from heart, kidney or liver disease are advised to limit any strenuous physical activity to prevent complications brought about their condition. Therapists will often provide them with an extensive program that will enable them to do any physical activity in the future.
First aid and treatment
Helping a person suffering from water intoxication during the first few hours of its onset is vital and the following steps can be taken to act as first aid and prevent the condition from taking its course.
Keep them calm – as with any injury or illness, it is important to keep the patient calm. Sit them in a cool, dry place and make sure they are comfortable. Assure them that help is one the way and that everything will be fine. If the patient is restless, give them something to do with their hands, a simple task that would require no effort and will keep their mind off the situation.
- Fluid restriction – water intoxication means that they have had too much already and we should make sure that they would have limited access to water and any other type of liquid. If they have to drink, give them controlled portions to prevent recursion.
- Salty food – if the patient feels the need to feed, give them food with high salt content. This would significantly increase their sodium levels once the salt is absorbed by the body.
- Medication – providing patients with medication can sometimes backfire, especially without proper training and information. Some generic medicines like aspirin and ibuprofen often cause an adverse reaction instead of alleviating the symptoms. The most a first aider can give them are oral rehydration salts which will help the patient gain their electrolyte and sodium balance back.
- Call an ambulance – immediately call an ambulance once a person you may or may not know suffers one or more of the symptoms for water intoxication.
Treatment for mild water intoxication is usually the restriction of fluids but once professional care is introduced the following are some of the steps taken to treat acute to severe cases:
- Fluid restriction – patients are often disallowed from drinking water or any other fluid directly, they are given intravenously and monitored for their sodium levels. Depending on the gravity of situation, the saline solution is adjusted to meet the needs of the patient.
- Medication – diuretics are often administered to increase urination, thus lowering the volume of fluids present in the body. Some medications are also given to reduce persistent symptoms and treat the underlying medical cause of water intoxication.
- Consultation – continuous consultation with your physician is needed to ensure that there is no permanent complication resulting from water intoxication. Maintenance medication may also be provided as needed.
Water intoxication is not as simple as it sounds.
Proper preparation, urgent attention and the right information is needed to prevent this illness from happening to you and those around you.
To keep you informed about the symptoms and treatments for overhydration, see our earlier article on this topic.