Water Intoxication: Risks and Recovery Tips

Questions about water intoxication?

Hello Doctor, I have been taking antibiotics recently, and my doctor advised me to drink plenty of water.
I have also seen news about people developing esophageal ulcers due to not drinking enough water.
As a result, I have been intentionally drinking a lot of water.
I would like to ask you: 1.
Under what circumstances can acute water intoxication occur? 2.
Can water intoxication be resolved by simply not drinking water? Thank you.

KSD, 10~19 year old female. Ask Date: 2019/03/21

Dr. Xiao Yongxun reply Family Medicine

1.
Water intoxication refers to an increase in body water relative to a decrease in ion concentration.
Water intoxication leads to a decrease in the effective osmotic concentration of plasma but does not cause localized or widespread fluid accumulation in the body; thus, it differs from the general meaning of edema.

2.
Compulsive excessive drinking behavior can be defined as the intake of large volumes of water (approximately 4 to 20 liters per day), with patients having no underlying organic disease.
Assouly et al.
suggest that the incidence of excessive drinking behavior in chronic psychiatric patients is about 6 to 17%, with 80% of these being patients with schizophrenia.
Some patients may develop symptoms of hyponatremia, leading to what is known as PIP syndrome (the syndrome of psychosis, intermittent hyponatremia, and polydipsia).
In this case, patients may experience hyponatremia and water intoxication, resulting in three conditions: thirst, abnormal secretion of antidiuretic hormone (ADH), or excessive renal response to ADH, and central nervous system lesions.
In summary, the hyponatremia caused by water intoxication can lead to confusion, drowsiness, psychiatric symptoms, seizures, and even death.
3.
The phenomenon of excessive drinking behavior and water intoxication is commonly observed in patients with chronic psychiatric disorders, particularly those with schizophrenia.
According to estimates by Leon et al., more than 20% of chronic psychiatric patients have exhibited excessive drinking behavior, and over 5% have a history of water intoxication.
Most patients experiencing this phenomenon are chronic psychiatric patients, often residing in long-term care facilities, where healthcare personnel may not monitor the patients' fluid intake closely.
When questioned, patients often deny excessive drinking until they develop severe hyponatremia due to excessive fluid intake, leading to water intoxication, which manifests as confusion and agitation, prompting healthcare personnel to take notice.
According to estimates by Vieweg et al., water intoxication accounts for approximately 18.5% of deaths in patients with schizophrenia under the age of 53.
4.
If water intoxication occurs, along with symptoms of hyponatremia, confusion, and agitation, hospitalization for treatment is necessary.
Your physician may advise you to drink more water, possibly to enhance the elimination of metabolic waste from antibiotics to avoid side effects.
You should drink an adequate amount of water and maintain normal urination without excessive concern.
As for drug-induced esophagitis or esophageal ulcers (pill esophagitis or esophageal ulcer), these are often due to taking medication without sufficient water, causing the medication to remain in the esophagus and irritate the mucosa, leading to esophagitis or ulcers.
If you have further questions, please discuss them with your attending physician.

Reply Date: 2019/03/21

More Info

Water intoxication, also known as water poisoning or hyperhydration, occurs when an individual consumes an excessive amount of water in a short period, leading to an electrolyte imbalance in the body. This condition can be serious and even life-threatening if not addressed promptly. Here’s a detailed overview of the risks associated with water intoxication and recovery tips.

1. Understanding Acute Water Intoxication
Acute water intoxication typically occurs when someone drinks an excessive amount of water—often several liters—within a few hours. This can overwhelm the kidneys' ability to excrete water, leading to a dilution of sodium levels in the blood, a condition known as hyponatremia. Sodium is crucial for maintaining fluid balance in and around cells, and when its levels drop too low, it can cause cells to swell.

Risk Factors for Acute Water Intoxication:
- Endurance Sports: Athletes, particularly those participating in endurance events, may consume large quantities of water to stay hydrated, sometimes neglecting to replenish electrolytes.

- Psychogenic Polydipsia: This is a psychological condition where individuals feel compelled to drink excessive amounts of water.

- Certain Medical Conditions: Conditions like kidney disease can impair the body's ability to excrete water, increasing the risk of intoxication.

- Medications: Some medications can cause increased thirst or fluid retention, contributing to the risk.

Symptoms of Water Intoxication:
- Nausea and Vomiting: Early signs often include gastrointestinal distress.

- Headaches: As the brain swells, pressure increases, leading to headaches.

- Confusion and Disorientation: Neurological symptoms can arise due to swelling in the brain.

- Seizures: Severe cases can lead to seizures due to significant electrolyte imbalances.

- Coma or Death: In extreme cases, untreated water intoxication can lead to coma or death.

2. Recovery from Water Intoxication
If someone suspects they are experiencing water intoxication, it is crucial to seek medical attention immediately. Treatment typically involves:
- Restricting Fluid Intake: The first step in recovery is to stop drinking water and other fluids.

- Electrolyte Replacement: Medical professionals may administer intravenous (IV) fluids containing electrolytes to restore balance.

- Monitoring: Continuous monitoring of vital signs and electrolyte levels is essential to ensure recovery and prevent complications.

3. Preventing Water Intoxication
To avoid the risks associated with water intoxication, consider the following tips:
- Listen to Your Body: Drink when you are thirsty rather than forcing yourself to consume large amounts of water.

- Balance Hydration with Electrolytes: If engaging in prolonged physical activity, consider electrolyte-replenishing drinks instead of just water.

- Educate Yourself: Understanding your body’s hydration needs can help prevent both dehydration and overhydration.

Conclusion
While staying hydrated is essential, especially when taking medications like antibiotics, it is crucial to strike a balance. Drinking water is vital for health, but excessive consumption can lead to severe health risks. If you have concerns about your hydration levels or experience symptoms of water intoxication, it is advisable to consult with a healthcare professional for personalized guidance. Always prioritize a balanced approach to hydration, considering both fluid and electrolyte intake, to maintain optimal health.

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