WATER POISONING - DRINKING TOO MUCH WATER KILLS

CHRONIC water intoxication

CHRONIC water intoxication occurs mainly as a secondary complication of other metabolic disorders:

Inappropriate antidiuretic hormone secretion (antidiuretic hormone - ADH), also called ailment secretion inappropriate antidiuretic hormone (SIADH). As it is easy to understand, it is the hormonal hypersecretion of ADH which inexorably causes the excessive reduction (by dilution) of extracellular sodium (hyponatremia) due to an exaggerated reabsorption of water in the kidney.

Abuse of antidiuretic drugs (desmopressin, chlorpropamide, acetaminophen and indomethacin), which enhance the action of ADH and inhibit renal regulation.

Deficit of glucocorticoids (steroid hormones produced by the adrenal gland).

Chronic nephropathies, which cause a reduction in glomerular filtrate by increasing body hydration and consequently diluting the sodium contained.

Myxedema, a typical condition of hypothyroidism; it determines an accumulation of hyperosmotic substances in the subcutis which, recalling water, favor the recall of interstitial fluids.

Potassium depletion, also referred to as hypokalaemia or hypokalaemia.

The treatment of CHRONIC water intoxication can be carried out by eliminating or reducing the primary triggering factor.

ACUTE water intoxication

ACUTE water intoxication can arise in a short time; to determine the rapidity of onset are the importance and the typology the etiological cause:

Correction of acute hypovolaemia; this condition is caused by an acute pathological reduction in plasma volume which MUST be urgently countered by drug therapy. If the treatment is excessive or not well balanced in the joint supply of electrolytes, it is possible to obtain the opposite effect for overhydration with ACUTE water intoxication.

Early postoperative.

Single administration of ADH-like drugs.

Psychogenic polydipsia, state or FEELING of intense thirst which causes the subject to ingest large quantities of fluids.

Excessive dilution of formulated milk, which determines an overhydration of the child with a consequent increase in the dilution of body sodium.

Error in the hydration of the endurance sportsman; this condition occurs in the athlete but only as a result of excessive sweating and lack of mineral salts (including Na). This condition determines a metabolic decompensation better known as CEREBRAL HYPONATRIEMIA.
In case of profuse and prolonged sweating, typical of marathon runners or cyclists who compete in the summer months, the sodium concentrations in the blood are reduced due to mineral losses with sweat. The same condition can affect "improvised" sportsmen, in which the mechanisms of heat dispersion and control of mineral losses are certainly not as optimized as in the case of professional sportsmen. In both cases, in addition to natriemia, the volume (plasma volume) also tends to decrease due to water losses. If in such circumstances the rehydration takes place through water poor in sodium, the lack of the mineral in the drink causes the plasma sodium to be further diluted (the water taken expands the plasma volume so, although equal in absolute terms, the concentration of sodium per unit of blood decreases by dilution, see figure below). We will then have the typical symptoms of water intoxication.
For this reason, after and during a prolonged effort, rehydration must first be carried out gradually (avoiding drinking too much water in a short time), preferring isotonic drinks or moderately mineralized waters.

Both CHRONIC water intoxication and acute water intoxication represent rather rare pathological forms; however, both are often accompanied by other organic or psychogenic disturbances; therefore, it is also desirable that the clinical manifestation occurs more often in the hospital setting or, similarly, that the subject is subjected to frequent and systematic monitoring; in this case, the specialist intervention SHOULD be sufficient to avoid the aggravation of the water intoxication.

Characteristic symptoms

Water intoxication gives rise to the relative symptoms only when the sodium levels are NO longer sufficient to counteract the level of hydration; this means that the relative visible and admirable clinical signs are independent of the differentiation between chronic disorder or acute disorder and they share both pathological forms.
The most frequent symptoms are nausea and vomiting which, if left untreated, can lead to coma. Water intoxication can also trigger decidedly significant mental effects which, if promptly identified and correlated to hyperhydration and hyponatremia, favor early diagnosis and the statistical reduction of the inauspicious course; water intoxication frequently determines (see cerebral hyponatremia ) confusional states, loss of orientation and hallucinations. In this case, if the specialist DOES NOT possess sufficient elements for the timely recognition of water intoxication, the need for differential diagnosis from SCHIZOPHRENIA (which is common for hallucinations and state confusional).
Rarer, but also recognizable in the blood for the enzymatic markers of cytolysis, is the breakdown of muscle cells, better defined as rhabdomyolysis.

Prevent and cure water intoxication

In order to prevent water intoxication, it is essential to promptly stop the secondary effects attributable to the pathologies also responsible for systemic hyperhydration. Each case is unique, but by following the principle of early diagnosis it is possible to minimize the risk of severe or poor prognosis.
Studies carried out on water intoxication have shown that, by drinking up to 10-20 liters of water in a few hours, death can occur; therefore, in order to prevent any negative effects, it is strongly recommended NOT to exceed 1-1 , 5 liters of water / hour to avoid reducing plasma sodium concentrations below 110-120mmol / l (<90-105mmol / l the first symptoms of SERIOUS entity are identified).
The only therapy useful for the treatment of water intoxication is the INTERRUPTION OF HYDRATION associated with DIURETIC DRUG THERAPY with furosemide (loop diuretic).