Water intoxication

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Water intoxication

  1. 1. Salum Mkata
  2. 2. Water intoxication  Strange but True: Drinking Too Much Water Can Kill  In a hydration-obsessed culture, people can and do drink themselves to death.  Earlier this year, a 28-year-old California woman died after competing in a radio station's on-air water- drinking contest. After downing some six liters of water in three hours in the "Hold Your Wee for a Wii" (Nintendo game console) contest, Jennifer Strange vomited, went home with a splitting headache, and died from so-called water intoxication
  3. 3. Intro: water intoxication Water intoxication, also known as water poisoning or dilutional hyponatremia, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by over-hydration. Water, just like any other substance, can be considered a poison when over-consumed in a specific period of time. Water intoxication mostly occurs when water is being consumed in a high quantity without giving the body the proper nutrients it needs to be healthy.
  4. 4. Cont; Excess of body water may also be a result of a medical condition or improper treatment; see "hyponatremia" for some examples. Water is considered the least toxic chemical compound, with a LD50 of 90 g/kg or more in rats.
  5. 5. How can happen Under normal circumstances, accidentally consuming too much water is exceptionally rare. Nearly all deaths related to water intoxication in normal individuals have resulted either from 1. water drinking contests in which individuals attempt to consume large amounts of water, or 2. long bouts of intensive exercise during which electrolytes are not properly replenished, yet huge amounts of fluid are still consumed
  6. 6. Cont: Moreover, water cure, a method of torture in which the victim is forced to consume excessive amounts of water, can cause water intoxication.
  7. 7. The Water Torture — Facsimile of a woodcut in J. Damhoudère's Praxis Rerum Criminalium, Antwerp, 1556.
  8. 8. Risk factors • Low body mass (infants) It can be very easy for children under one year old to absorb too much water, especially if the child is under nine months old. Because of their small body mass, it is easy to take in a large amount of water relative to body mass and total body sodium stores • Endurance sports Marathon runners are susceptible to water intoxication if they drink too much while running. This is caused when sodium levels drop below 135 mmol/L when athletes consume large amounts of fluid. This has been noted to be the result of the encouragement of excessive fluid replacement by various guidelines. This has largely been identified in marathon runners as a dilutional hyponatremia.
  9. 9. Cont. • Overexertion and heat stress Any activity or situation that promotes heavy sweating can lead to water intoxication when water is consumed to replace lost fluids. Persons working in extreme heat and/or humidity for long periods must take care to drink and eat in ways that help to maintain electrolyte balance. People using drugs such as MDMA (often referred to colloquially as "Ecstasy") may overexert themselves, perspire heavily, and then drink large amounts of water to rehydrate, leading to electrolyte imbalance and water intoxication . • Psychiatric conditions Psychogenic polydipsia is the psychiatric condition in which patients feel compelled to drink large quantities of water, thus putting them at risk of water intoxication. This condition can be especially dangerous if the patient also exhibits other psychiatric indications (as is often the case), as the care-takers might misinterpret the hyponatremic symptoms.
  10. 10. Cont. • Iatrogenic When an unconscious person is being fed intravenously (for example, total parenteral nutrition) or via a nasogastric tube the fluids given must be carefully balanced in composition to match fluids and electrolytes lost. These fluids are typically hypertonic, and so water is often co-administered. If the electrolytes are not monitored (even in an ambulatory patient) either hypernatremia or hyponatremia may result. N.B: Some neurological/psychiatric medications (Oxcarbazepine, among others) have been found to cause hyponatremia in some patients. Patients with diabetes insipidus are particularly vulnerable due to rapid fluid processing
  11. 11. Pathophysiology  At the onset of this condition, fluid outside the cells has an excessively low amount of solutes (such as sodium (hyponatremia) and other electrolytes) in comparison to that inside the cells causing the fluid to shift through (via osmosis) into the cells to balance its concentration. This causes the cells to swell. In the brain, this swelling increases intracranial pressure (ICP).  It is this increase in pressure which leads to the first observable symptoms of water intoxication: headache, personality changes, changes in behavior, confusion, irritability, and drowsiness.
  12. 12. Cont.  These are sometimes followed by difficulty breathing during exertion, muscle weakness & pain, twitching, or cramping, nausea, vomiting, thirst, and a dulled ability to perceive and interpret sensory information  As the condition persists, papillary and vital signs may result including bradycardia and widened pulse pressure.  The cells in the brain may swell to the point where blood flow is interrupted resulting in cerebral edema. Swollen brain cells may also apply pressure to the brain stem causing central nervous system dysfunction. Both cerebral edema and interference with the central nervous system are dangerous and could result in seizures, brain damage, coma or death.
  13. 13. Prevention It's Not How Much You Drink, It's How Fast You Drink It! The kidneys of a healthy adult can process fifteen liters of water a day! You are unlikely to suffer from water intoxication, even if you drink a lot of water, as long as you drink over time as opposed to intaking an enormous volume at one time. As a general guideline, most adults need about three quarts of fluid each day. Much of that water comes from food, so 8-12 eight ounce glasses a day is a common recommended intake. You may need more water if the weather is very warm or very dry, if you are exercising, or if you are taking certain medications. The bottom line is this: it's possible to drink too much water, but unless you are running a marathon or an infant, water intoxication is a very uncommon condition.
  14. 14. Cont.  Water intoxication can be prevented if a person's intake of water does not grossly exceed his or her losses.
  15. 15. Treatment Mild intoxication may remain asymptomatic and require only fluid restriction. In more severe cases, treatment consists of: • Diuretics to increase urination, which are most effective for excess blood volume. Such as furosamide (lasix) • Vasopressin receptor antagonists. Lixivaptan Mozavaptan Satavaptan Tolvaptan
  16. 16. References  Noakes TD, Wilson G, Gray DA, Lambert MI, Dennis SC (October 2001). "Peak rates of diuresis in healthy humans during oral fluid overload". S. Afr. Med. J. 91 (10): 852–7. PMID 11732457. — refers to a renal excretion capacity of 3 ml/h  http://learn.caim.yale.edu/chemsafe/references/dose.html [1] — see to Section 11:  Toxicological Information for the LD50 verification Water Intoxication in Infants Almond CS, Shin AY, Fortescue EB, et al. (April 2005).  "Hyponatremia among runners in the Boston Marathon". N. Engl. J. Med. 352 (15): 1550–6. doi:10.1056/NEJMoa043901. PMID 15829535.
  17. 17. Thank you for following Have a nice studies

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