What is Water Toxicity?
Water toxicity, or drinking too much water, can happen for various reasons and can be hard to identify because it shows non-specific symptoms like changes in mental state, confusion, disorientation, feeling nauseous, and vomiting. Sometimes, this could even seem like a mental disorder. The variety in symptoms makes it hard to diagnose correctly from the start. To avoid severe consequences like seizures, falling into a coma, or even death, it’s crucial to detect water toxicity early. If left untreated, it could lead to fatal outcomes.
What Causes Water Toxicity?
It’s very uncommon for water toxicity to occur normally because our bodies carefully manage the amount of water we carry. However, there are situations which could lead to drinking too much water. These include:
Exercise: After working out for a long time, you might drink water to compensate for the lost fluid, but this doesn’t replace lost salts and minerals, called electrolytes.
Psychogenic polydipsia: This is a condition where you might have an ongoing feeling of thirst and end up drinking too much water.
In some extreme cases, people might drink excessive water as a part of prison torture or during water drinking competitions.
Also, when your ADH (anti-diuretic hormone) levels are high like during a stomach bug which leads to loss of water from your body, you tend to drink more water. The ADH hormone controls your body’s water balance.
Risk Factors and Frequency for Water Toxicity
Water intoxication, while not very common, can happen in various situations. It’s often linked to activities like contests or instances of alcohol intoxication.
Signs and Symptoms of Water Toxicity
People with this condition may initially show symptoms that look like psychosis. These symptoms can include a angry or confused state, along with delusions, hallucinations, confusion, and disorientation. Any delay in diagnosis or insufficient treatment can worsen these symptoms. This could lead to seizures, delirium, and even coma.
- Exhibiting a hostile or delirious state
- Experiencing delusions or hallucinations
- Feeling confused or disoriented
- Having seizures
- Experiencing delirium
- Falling into a coma
Testing for Water Toxicity
If you’re being treated for water toxicity, one of the main things your doctor will consider is a condition called hyponatremia (low sodium in your blood). This condition can greatly influence the treatment plan. To help understand your body’s hydration status, your doctor may use different methods like:
- hydration markers like osmolarity (a measure of the concentration of your body fluids),
- estimating your water balance (how much water you’re taking in and losing).
Here are some of the key strategies in these methods:
Serum Sodium
This is the measurement of the amount of sodium in your blood. This is very important as it helps to understand the severity of your condition and the kind of treatment you need.
Plasma and Urine Osmolarity
This method evaluates the concentration of your body fluids. This is not a routine test, but when performed, it can be a great support in diagnosing your condition.
Water Intake and Output
This method is all about measuring and recording how much water you intake (drink or receive from foods) and how much water you lose (through urine and stool). This way, the doctor can estimate your body water balance over a particular period.
Body Weight
Changes in your body weight can be an excellent indicator of your water balance. This is particularly true if measurements are taken under similar conditions and compared over time. For it to work best, previous weight data for comparison are needed.
Treatment Options for Water Toxicity
The aim of treatment for hyponatremia (low sodium levels in your blood) is to avoid severe brain damage, alleviate the symptoms, stop any further decrease in sodium levels, and avoid correcting sodium levels too quickly.
Osmotic demyelination syndrome (ODS), a brain disorder, may occur if the treatment for hyponatremia is done too aggressively – that is, if the sodium level raises more quickly than it should. It usually happens when the sodium level increases faster than 18 mEq/L within 48 hours or more than 10 to 12 mEq/L in 24 hours. As such, remedies should be administered carefully and the sodium concentration change should be monitored closely on a daily basis, especially during the first few hours of treatment.
The type of treatment provided initially or within six hours of excessive water consumption will depend on whether the patient is showing symptoms. This is because water can move into the brain through a process called osmosis when sodium levels are low, which could result in brain swelling, a potentially life-threatening condition. Thus, any signs of hyponatremia should be treated promptly and may include administering a hypertonic saline solution (essentially, strong and concentrated salt water).
For patients who are not showing symptoms but whose blood sodium level is lower than 130 mEq/L, usually a small amount of hypertonic saline solution is given straight away to prevent further declines in the sodium level. However, if the body starts to correct the low sodium levels independently, then hypertonic saline is avoided. Instead, urine output and concentration are monitored closely to detect any signs of self-regulation or correction.
In cases where symptoms are present and the sodium level in blood is less than 130 mEq/L, treatment involves giving a larger dose of hypertonic saline solution, to prevent severe brain damage. The aim of the therapy in such cases is to increase the sodium level by 4 to 6 mEq/L within a couple of hours. This rise in sodium level cam help prevent severe brain damage and alleviate the symptoms.
According to medical findings, in severe cases of hyponatremia, the fastest and most effective way to raise the sodium level in the blood is by administering a hypertonic saline solution. Other medications like vasopressin antagonists (e.g., vaptans) or mannitol are usually avoided as they have some limitations – for instance, mannitol can worsen hyponatremia and might even damage your kidneys. Along with medication, limiting water intake and discontinuing any drugs that might be causing hyponatremia are also necessary precautions.
Regular monitoring of hyponatremic patients is crucial, and any changes in mental state or symptoms should be checked every hour. The goal is to increase sodium levels by 4-6 mEq/L until the symptoms disappear.
What else can Water Toxicity be?
It’s crucial to consider reversible causes of polydipsia (excessive thirst) when figuring out why someone might have water toxicity. For example, people with diabetes could be mistakenly diagnosed with polydipsia, especially if they’re taking antipsychotic medications, as these drugs can result in metabolic syndrome.
In long-term mental illness sufferers, an overly dry mouth caused by anticholinergic drugs could have a slight but generally insignificant role in the disease. Also, patients with primary polydipsia (excessive thirst without a known medical cause) are regularly misdiagnosed as having diabetes insipidus. The latter is a condition where the body’s ability to control water balance is impaired, often due to low or deficient levels of antidiuretic hormone (ADH). However, polydipsia itself can reduce the kidney’s response to ADH because it down-regulates aquaporin-2 channels (the proteins that regulate water balance in the body).
