water intoxication
TRANSCRIPT
Wakefield 1
Michael Wakefield
Joan L. Anderson, MD
Biology 261 – Anatomy and Physiology
May 20, 2008
Water Intoxication and Its Deadly Effects
I decided on this topic because of a question in class regarding how hyponatremia was
related to the water intoxication in a particular case that was discussed. The discussion
centered on the story of Jennifer Strange, a woman from Sacramento California, who had
entered a water-drinking contest sponsored by a local radio station, Sacramento-based
KDND-FM, during January 2007 (Conroy, n.d.). She died from water intoxication. The fact
that the contest was called "Hold your wee for a Wii" led me to believe that “not urinating”
was related to the hyponatremia. During my research for this paper, I would discover that this
is untrue. I thought about and attempted to answer this question in class, but I was way off
base. As a result of my lack of knowledge on the subject, I decided that I was going to take
the opportunity to write about this incident and its consequences and subsequently educate
myself in the process.
Now for some physiology background about water intoxication. Water intoxication or
hypotonic hydration, as it is referred to in our textbook, is defined as an extraordinary amount
of water drunk very quickly that results in a type of cellular overhydration (Marieb, 2006, p.
1042). Our blood contains electrolytes (particularly sodium compounds, such as sodium
chloride) in concentrations that must be held within very narrow limits. Water enters the body
orally or intravenously and leaves the body primarily in urine, sweat, and water vapor. A
person with healthy kidneys can excrete about 900 milliliters of water per hour (0.24 gal/hr).
However, this must be regulated by potential water losses via other routes. For example, a
person who is perspiring heavily may lose around 1 liter an hour (0.26 gal/hr) of water
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through perspiration alone, thereby raising the amount of water that must be consumed before
an individual crosses the threshold for water intoxication. The problem is further complicated
by the amount of electrolytes lost in urine or sweat, which is variable within a range
controlled by the body's regulatory mechanisms (Grandjean, Reimers, Buyckx, 2003). If
water enters the body more quickly than it can be removed, body fluids are diluted and a
potentially dangerous shift in electrolyte balance occurs. In other words, the body has too
much water and not enough electrolytes, or sodium in the case of hyponatremia.
How does hyponatremia relate to the water intoxication in this case? According to the
journal article, Hyponatremia among Runners in the Boston Marathon, hyponatremia is
defined as a serum sodium concentration of 135 mmol per liter or less; serious or critical
hyponatremia is defined as 120 mmol per liter or less. Normal serum sodium levels are
typically 280-300 mOsm/kg (Craig, 2007). Stimulation of thirst, secretion of ADH, feedback
mechanisms of the renin-angiotensin-aldosterone system, and variations in renal handling of
filtered sodium regulate our serum sodium concentration. This regulation is accomplished by
the stimulation of hypothalamic osmoreceptors, which, in turn, cause an increase in thirst and
in circulating levels of ADH. ADH increases free water reabsorption from the urine, yielding
urine of low volume and relatively high osmolarity and, as a result, returning serum
osmolarity to normal (Craig, 2007). As previously stated, when an extraordinary amount of
water is drunk very quickly, cellular overhydration occurs. As a result of this increased
amount of extracellular fluid (ECF), the amount of sodium in the body might be normal, but
is now diluted out of the blood plasma and into the ECF. Hyponatremia is caused by
insufficient sodium in the blood plasma, which in turn causes an osmotic shift of water from
extracellular fluid (outside of cells) to intracellular fluid (within cells). The cells swell as a
result of changes in osmotic pressure and may begin to cease functioning.
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So, what are the symptoms? Initial symptoms typically include light-headedness,
sometimes accompanied by nausea, vomiting, and headache. Sodium levels below 100
mmol/l (2.3 g/l) frequently result in cerebral edema, seizures, coma, and death within a few
hours of drinking the excess water (Almond et al., 2005). Severe hyponatremia may cause
osmotic shift of water from the plasma into the brain cells. As the hyponatremia worsens,
confusion, diminished reflexes, convulsions, stupor or coma may occur. Since nausea is,
itself, a stimulus for the release of ADH, which promotes the retention of water, a “positive
feedback loop” may be created and the potential for a vicious circle of hyponatremia and its
symptoms exists (Hyponatremia, n.d.).
According to the Sacramento County coroner, preliminary autopsy findings indicate
Strange died of water intoxication. The newspaper article from CBS/AP states that Strange
had told the DJ, live on the air, before leaving the station, "My head hurts. They keep telling
me that it's the water...that it will tell my head to hurt and it'll make me puke." After the
contest, Strange called in sick to work, crying and saying she was heading home in terrible
pain. About five hours later, Strange – who had three children - was found dead by her
mother at her home in the Sacramento suburb of Rancho Cordova. It appears that the “head
hurting” remark was an initial symptom of hyponatremia, which was the result of the water
intoxication.
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Works Cited
Almond, Christopher S. D., Shin, Andrew Y., Fortescue, Elizabeth B., Mannix, Rebekah
C., et al. (2005). Hyponatremia among Runners in the Boston Marathon. The New
England Journal of Medicine, 352(15), 1550-6. Retrieved May 21, 2008, from
Platinum Full Text Periodicals database. (Document ID: 823349251).
Conroy, Scott (n.d.). Ten Fired After Radio Contest Tragedy, Woman Died Despite Listener
Warning On Danger Of Chugging Too Much Water - CBS News [Webpage].
Retrieved Tuesday, May 20, 2008, from
http://www.cbsnews.com/stories/2007/01/17/entertainment/main2365259.shtml.
Craig, Sandy MD. (January 18, 2007). eMedicine - Hyponatremia : Article by Sandy Craig
[Webpage]. Retrieved Wednesday, May 21, 2008, from
http://www.emedicine.com/emerg/topic275.htm.
Grandjean, Ann C., Reimers, Kristin J., Buyckx, Maxime E. (2003). Hydration: Issues for the
21st century. Nutrition Reviews, 61(8), 261-71. Retrieved May 21, 2008, from
Platinum Full Text Periodicals database. (Document ID: 430986531).
Hyponatremia. (n.d.). Hyponatremia - Wikipedia, the free encyclopedia [Webpage].
Retrieved Tuesday, May 20, 2008, from http://en.wikipedia.org/wiki/Hyponatremia.
Marieb, Elaine N. (2006). Human Anatomy and Physiology (Seventh ed.). San Francisco,
CA: Pearson Benjamin Cummings
Water Intox. (n.d.). Water intoxication - Wikipedia, the free encyclopedia [Webpage].
Retrieved Tuesday, May 20, 2008, from
http://en.wikipedia.org/wiki/Water_intoxication.