Patterico's Pontifications

1/16/2007

Water Intoxication

Filed under: General — Patterico @ 8:08 pm

Did you know you can die from drinking too much water? Here is a story of a woman who drank two gallons as part of a radio contest and was later found dead of “water intoxication.”

Weird. You learn something new every day.

42 Responses to “Water Intoxication”

  1. This is the perfect post for MD in Philly. Was there already some problem with her kidneys or her heart?

    nk (5a2f98)

  2. H2O OD is also a danger for athletes who overcompensate for dehydration. Better to drink Gatorate or something else with electrolytes.

    Bradley J. Fikes (1c6fc4)

  3. You’ve probably heard about water intoxication if you played football in Texas recently. Even for hydration, moderation is the key.

    DRJ (51a774)

  4. This lady died from Dihydrogen Monoxide, a deadly poison which should be banned.

    http://www.dhmo.org/facts.html

    Wesson (c20d28)

  5. she died from hyponatremia, a situation resulting from too much water dilution around her cells, and consequently, too low of a sodium ion concentration.
    ten heads rolled at the station in consequence, like they were all somehow responsible, yow, not to minimize this tragedy of a mom dying for a wii console, but corporate america sure knows how to cauterize a pr wound, don’t it?

    assistant devil's advocate (53b024)

  6. A local woman (here in SoFla) is now facing murder charges because she killed a young girl by making her drink excessive amounts of water.

    If I can find a writeup online, I’ll post it in a later comment.

    kishnevi (d6f5a0)

  7. #4, kind of like that other deadly poison, CO2, that is poisoning our atmosphere, causing the planet to overheat, melting the polar ice caps, flooding all coastal areas and killing the poor polar bears.

    Oops, almost forgot that it’s also filling the western half of the country with snow, freezing the California citrus crop and creating ice storms in Texas and Oklahoma.

    Overfilling reservoirs, causing us to have to drink more water …

    Harry Arthur (b318a5)

  8. Yeah: this is commonly understood in the club scene. Certain club drugs have the effect of making you feel thirsty, and the short attention span + feeling thirsty means water intoxication is a risk you have to guard against.

    aphrael (9e8ccd)

  9. It’s all George Bush’s fault. Since he’s causing global warming by not enforcing the Lyoto Protocols, the polar ice caps are melting, producing more free water.

    Water is dangerous, and must be strictly regulated by the Food and Drug Administration!

    Dana (3e4784)

  10. I recommend the Sacramento Bee website for more information on this incident (Registration required, but use bugmenot if you’re so inclined).

    ClericalGal (688b7b)

  11. Here’s a link covering a few cases of liquid homicide:
    http://www.cnn.com/2003/LAW/05/07/ctv.death.by.water/

    As for the status of the Florida case, let’s just say the wheels of justice are grinding very very slowly:
    http://www.miami.com/mld/miamiherald/2007/01/06/news/local/states/florida/counties/broward_county/16395492.htm

    kishnevi (7a9e8b)

  12. Thank you, nk, for the introduction. Ada’s comment is correct.

    Further pontification if interested:
    What happens after the concentration of sodium (and total electrolytes) in the blood precipitously decreases, the dreaded poison dihydrooxygen rushes into cells, including brain cells, to equally dilute the fluid inside the cells. When it comes to the brain, swelling cells don’t have any place to swell, causing increased intracranial pressure, altering brain function and perhaps pushing the brainstem (where the brain and spinal cord meet) down into the spinal column. When the brain stem is squeezed by the tight confines of the vertebrae in the spinal column, the center that controls breathing is cut off, and breathing stops. Alternatively, the rapid changes can trigger seizures which can persist and result in death in this situation.*
    Textbooks will say that water intoxication is rare, usually occurring in the context of a psychiatric illness where compulsive and irrational behaviors predominate (also, some psych drugs can contribute if they are not doing what they are supposed to). This is because it is hard for an otherwise healthy person to override their own feedback mechanisms. Precipitous changes from dehydration and rehydration with the wrong fluids can can cause this as well, as posts #2 and #3 state. It would be interesting to know if the person did have other physical or mental health issues that contributed to the problem.**
    I also agree with ada that the station’s response is a bit curious. On the face of it I would not necessarily think the employees should be fired, which will not help the person’s family anyway (but try to minimize liability for the station???), but we don’t know all of the background and details.

    Indeed, all things in moderation. I actually use this possibility top counter the “if it’s natural it must be good for you” argument, along with poison ivy tea.

    *To clarify, FWIW, seizures per se are not typically life threatening. The underlying cause and risk of injury (if driving a car, for example) are typically more the issue. When a seizure persists for a prolonged period (“status epilepticus”) the consequences can be devastating no matter what the underlying cause.
    **Kidney or heart problems could indeed be factors, but I will refrain from further blabbering for the moment, unless specific interest is raised.

    Now, the cause of death from “heavy water” intoxication is a totally different story, something for a “CSI” episode.

    MD in Philly (3d3f72)

  13. This is also a problem with Grand Canyon hikers. In the push to make sure they hydrate enough (normal metabolism in midsummer requires close to a gallon of water per day, so hiking with a backpack in the heat of the day can require twice as much) they sometimes overlook common salt, leading to hyponatremia.

    Simon Kenton (bfdffd)

  14. Drinking water to excess (or in inadequate amount) is unusual in conscious individuals but not that rare in ICU and nursing home patients. The regulation of sodium concentration is pretty effective but can be overwhelmed. Sweating loses salt, hence the replacement requires both. Drinking water when sweating heavily is just as dangerous. The drop in serum sodium leads to cerebral edema and that is usually the cause of death. Another possibility is arrhythmia. I’ve actually seen a few people addicted to water. One of them slept in her bathroom so she could be close to the faucet.

    Mike K (416363)

  15. 30 years ago I asked my high school biology teacher about water intoxication, and she laughed at me. I wish I could remember her name so I could send her this story.

    hcq (e5c27d)

  16. So, Gatorade actually is better than water?

    Jinnmabe (cc24db)

  17. I’m amazed. Not just by the story, although I had no idea one could be so afflicted, but by the knowledge of the commenters.

    Dwilkers (4f4ebf)

  18. md in philly, your reference to heavy water intoxication piqued my curiosity. heavy water is just ordinary water with all the hydrogen atoms in the form of the isotope deuterium, which is nonradioactive and occurs naturally at a frequency of about one percent of all hydrogen atoms. deuterium differs from ordinary hydrogen in only one respect; the nucleus has a neutron in addition to a proton, instead of being just a proton, and neutrons don’t get involved in ordinary chemical reactions, so….what’s the diff? after a hard workout, could you slake your thirst with a liter of evian heavy water with no ill effects? is the deuterium ratio the same in biological molecules as it is in the ocean?
    in some biological reactions, a proton comes off the water molecule to be incorporated into a larger biological molecule. a deuterium nucleus would have twice as much mass, requiring twice as much force to accelerate it to the same velocity, is this significant? i saw an interesting article last year about quantum tunneling at enzyme active sites suggesting that isotopic differences would affect the rate of catalysis, but the data was unclear and non-peer-reviewed. tell us doctor, how safe is heavy water to drink?

    assistant devil's advocate (2ef91f)

  19. Heavy Water toxicity…

    http://en.wikipedia.org/wiki/Heavy_water#Toxicity_in_humans

    Short version
    > Thus, it would take a week of drinking nothing but pure heavy water for a human to begin to feel ill, and 10 days to 2 weeks (depending on water intake) for severe poisoning and death.

    Of course it’s wikipedia so it’s merely slightly more reliable than AP. –snicker–

    Arthur (e928db)

  20. I’ve seen it myself. When I was in Kuwait after 9/11 I was stationed with some Marines. One female Jarhead drank so much water she had to be medevaced with heart-attack like symptoms.

    RCJP (7e1ac4)

  21. I used to bicycle long distances in the heat of Northern California. Gatorade is better than water because it has some electrolytes, but the best stuff is V8-it’s got tons of sodium and potassium and you can get it in any convenience store or gas station.

    Marty H (52fae7)

  22. Arthur, it was regular water (H2O) not heavy water (D2O) she was drinking.

    Mahatma Kane Jeeves (c44633)

  23. Esteemed colleagues-

    You are all too smart for me, and Wikipedia certainly has some advanced information in it.

    That said, I am not sure how wikipedia comes to the conclusion it does, and I would need to see them prove it.

    Ada, you are on the right track, as discussed in the Wikipedia discussion of “kinetic isotope effect” which is mentioned in the link there on heavy water. As discussed there, a chemical reaction that involves a deuterium atom is significantly slower than one involving typical hydrogen. If enough of the hydrogen atoms being exchanged in reactions inside the human body were replaced by deuterium, at some point everything would slow down at a biochemical level. A metabolic traffic jam at the molecular level would result, the speed of every reaction that depended on the exchange of hydrogen atoms (i.e., a bunch) would be significantly slowed, with the effects additive or multiplied because of the interrelatedness of it all. From a forensics point of view, unless mass spectrometry was done on samples from the victim the cause of death would be unknown. Nothing would show on drug and poison screens, only a deuterium peak wildly out of proportion to hydrogen as expected if the appropriate test was done.

    My knowledge of this topic is the result of academic speculation long ago and far away as an undergrad working in a research lab at that Powerhouse of scientific inquiry, the University of Wisconsin. The bio-organic chemistry group I worked in did a lot of work studying enzyme mechanisms by synthesizing substrate compounds with deuterium replacing hydrogen at various locations and measuring the effect, if any, on the speed of the reaction. This speculation was offered by the professor in charge of the group and was said as a statement of fact, and I have had no reason to doubt the accuracy previously.

    Re water vs. gatorade- we all now know that rehydration with water only can be bad. We also know that trying to rehydrate by drinking ocean water will not work because it is too salty. Gatorade is touted as the perfect concentration, but I have been told by the coach and trainer of high-level fencers that Gatorade/water 50/50 is better. I have been too intellectually lazy to try to think it through.
    [Eating crow here, “Gatorade” got its name (I believe) because it was developed with the help of the Florida Gators football team- which is why its not called something else, like “BuckeyeAid”.]

    MD in Philly (3d3f72)

  24. Gatorade was field-tested on the Flordia Gators football team. Hence the name.

    Looks like the stuff works.

    Techie (476074)

  25. More people die every year from water overdose than have died as a result of marajuana overdose in the entire history of the Universe. We must move swiftly to list this very dangerous substance as a schedule 1 molecule. All kidding aside, patients with polydipsia must be hospitalized with 24 hour 1:1 supervision lest they drink themselves to death; anything- toilet, birdbath, mud puddle, vase full flowers- serves to tempt them.

    Jeff (52bc25)

  26. “It’s all George Bush’s fault. Since he’s causing global warming by not enforcing the Lyoto Protocols, the polar ice caps are melting, producing more free water.”

    -Dana

    More free salt water, which intelligent people drink on a daily basis… right, Dana?

    Or did you assume that the ice caps were neatly melting into 55-gallon drums, which could be used to hose off your Alabama driveway after taking the truck for a nice mud-run (or something along those lines)?

    Leviticus (68eff1)

  27. thank you, md in philly and arthur, i had always wondered what would happen if someone drank a lot of heavy water.
    i don’t recognize the university of wisconsin as a “powerhouse of scientific inquiry”, but i have heard that it is cutting edge in owning patents for new stuff produced in its facilities, and making money off its intellectual property portfolio. it’s also involved in astronomical activities as far away as california (the wiyn telescope@lick observatory).
    if gatorade had been invented just one state to the west, it would be dyed dark red and called something like “crimson tide”. hope the gators didn’t sell out their royalty interest to the corporations.

    assistant devil's advocate (2ef91f)

  28. [Math warning]
    Assuming she was an average sized woman, say 60 kg, and not morbidly obese, then her total body water content is approximately 33 kg. The intracellular water content is about 22 kg, and extracellular 11 kg. For the sake of argument, let us say she drank 9 liters (2 gallons = 7.5 liters). Let us also assume that she knew the contest format beforehand and emptied her bladder prior to drinking the water. That 9 liters of water would distribute itself in her total body water, with 6 liters going into the intracellular compartment, and 3 liters going into the extracellular compartment. Assuming a normal starting serum sodium level (140 milliequivalents per liter), her sodium level would be 110 mEq/L post-ingestion, which is definitely in the symptomatic range, especially when such a large electrolyte shift occurs so abruptly. These symptoms may include mental status changes, convulsions, coma, and death (as mentioned above). Obviously, this woman’s chances for an adverse outcome are greatly increased if she suffered from a preexisting medical condition, such as heart disease, kidney disease, or a seizure disorder. BTW, if the story is accurate in saying that she only ingested 7.5 liters of water, her serum sodium would still be 114 mEq/L, which is still in the possibly symptomatic range.

    Re the 50/50 Gatorade/water thing:
    Gatorade was essentially formulated to equal the composition of sweat, with some sugar for palatability and enhanced absorption. However, during physical exertion, sweat is not the only fluid loss. Respiratory losses can be signifcant, and those are pure water, so to avoid electrolyte imbalances they must be replaced with pure water. That, at least, is my take on why gatorade/water may be preferable. Also, it is possible that gatorade may cause some GI upset, particularly if ingested during intense physical activity, so it is diluted to mitigate that.

    MD in MD (38b362)

  29. “More free salt water, which intelligent people drink on a daily basis… right, Dana?

    Or did you assume that the ice caps were neatly melting into 55-gallon drums, which could be used to hose off your Alabama driveway after taking the truck for a nice mud-run (or something along those lines)?”

    So, the polar ice caps are full of salt? Are you sure about that?

    G (722480)

  30. Can you read, G?

    Leviticus (68eff1)

  31. Can you not answer a simple question?

    G (722480)

  32. Anyway, Leviticus, terribly sorry you can’t insult somebody properly.

    G (722480)

  33. Ok, Genius:

    1) Icecaps float around in large bodies of saltwater.

    2) Icecaps melt in large bodies of saltwater.

    3) G tries to separate saltwater from freshwater in order to drink freshwater.

    4) G fails, and subsequently dies.

    Dana’s statement (that melting polar icecaps would provide free potable water) was a stupid one, insofar as people don’t drink saltwater and polar icecaps don’t melt into small, portable containers.

    Is that clear enough for you?

    Leviticus (68eff1)

  34. To MD in MD- thanks for the discussion about the rationale for prefering Gatorade/water combo, makes sense.

    To ada-
    I am very happy that you can sleep undisturbed tonight, having to no longer ponder the effects of heavy water poisoning. No, I won’t send a bill;-).
    The crimson tide idea was great. Had a 10 yo boy been allowed to name it, it might have been “Gatorpee”, especially since the original was a yello-green, I believe.

    Their income from patents is indeed large, managed by the Wisconsin Alumni Research Foundation (WARF). The state gave the land and historically lots of funds to support the university, and the endeavors of the institution were to be shared for the betterment of the state. Vitamin metabolism was a big deal years ago, the blood thinner and rat poison warfarin was named after the WARF.
    I think the climate is often too humid for excellent star-gazing activities, so they make use of other places. I know they also observe from Arizona and orbit (the Hubble)-had a friend who did his astrophysics PhD there and visited Arizona a lot.

    I’m tempted to expand my claim on the merits of the UW, but I’ve overcome it (for the moment).
    Patterico will probably think twice before he posts his “thinking out loud” in the future- or edit me.

    MD in Philly (3d3f72)

  35. These DJ’s were informed of the possiblity that their water drinking contest could result in death by a caller. They said “Not to worry, they (refering to the contestants) signed a waver”.
    I am interested in your professional opinion. Are they guilty of a crime?

    Papertiger (0b82c2)

  36. […] Homicide detectives in Sacramento are looking into that death I told you about last night, of the woman who drank too much water and died of water intoxication — part of a radio contest to win a $250 game console. Meanwhile, her family is planning to sue: On Wednesday, attorneys for the Strange family said they planned to file a wrongful death lawsuit against the radio station on behalf of her husband and three children. Details of the suit were to be announced Thursday. […]

    Patterico’s Pontifications » DJs Joked About Contestants Dying of Water Intoxication; Sheriff Investigates; Family Plans to Sue (421107)

  37. professional gorge eaters (hotdogs, pies and so forth) drink liters of water before competitions to stretch their bellies for the big binge. they are well aware of the risks and seek a fine saturational balance. had more people been paying attention to this important new swallowing sport they’d have known of the water threat.

    lbo (f86e7d)

  38. “Ok, Genius:

    1) Icecaps float around in large bodies of saltwater.

    2) Icecaps melt in large bodies of saltwater.

    3) G tries to separate saltwater from freshwater in order to drink freshwater.

    4) G fails, and subsequently dies.

    Dana’s statement (that melting polar icecaps would provide free potable water) was a stupid one, insofar as people don’t drink saltwater and polar icecaps don’t melt into small, portable containers.

    Is that clear enough for you?”

    Okay, first of, Dana never said the icecaps would provide free potable water. She says simply “water.” I have no idea why you’re saying I would seperate the salt out of the water. I’d die just from the cold. Besides, I’m planning on the weather to do the seperating.

    G (722480)

  39. “More free salt water, which intelligent people drink on a daily basis… right, Dana?

    Or did you assume that the ice caps were neatly melting into 55-gallon drums, which could be used to hose off your Alabama driveway after taking the truck for a nice mud-run (or something along those lines)?”

    So, the polar ice caps are full of salt? Are you sure about that?

    Frozen saltwater DOES NOT retain any salt, so all the ice caps when they melt have perfectly healthy drinking water.

    Meyer (13a101)

  40. Does the fact that she was not able to urinate add to the problem? Is water from the urine reabsorbed into the bloodstream, adding to the problem? Could she have been in heart failure or had an arrhymnia due to electrolye imbalance?

    annie (8b44da)

  41. Reasonable questions (as long as you are not a medical resident). Not being able to urinate for 1 hour had little to do with it. If someone had compromised cardiac function they may go into heart failure prior to drinking enough for symptomatic hyponatremia, but no evidence of that from the story (she complained of headache, not shortness of breath, as well as being young with no cardiac history). Arrhythmias from electrolyte imbalance are typically associated with potassium levels, not sodium. Water intoxication effects sodium much more than potassium. (High potassium concentrations are within all cells, high sodium in the blood and body fluid between the cells.)

    MD in Philly (3d3f72)

  42. And remember all those wheat germ inhaling health freaks are always saying we should drink water insteae od cola screw them

    krazy kagu (a90e92)


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