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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

Wakefield 2 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.

Wakefield 3 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.

Wakefield 4 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.