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A Watery Warning

"Water toxicity can occur due to numerous etiologies but is challenging to diagnose as it presents with vague symptoms of altered mental status, disorientation, confusion, nausea, and vomiting which may resemble psychosis. It may be misdiagnosed on presentation, due to the variability of symptoms. To avoid more serious outcomes like seizures and coma early detection is vital. Untreated cases may also lead to death." National Library of Medicine, June, 2022.


I don’t ever want to go through what happened the weekend before Easter again, and I don’t want anyone else to go through it either.


Our son was disoriented and wandering around a parking lot when his wife found him

and took him to the emergency room. Admitted to ICU, his condition worsened. He was more disoriented, sometimes unrousable, and thought to have had a seizure.


Six-hundred miles away and terrified, I was going through diagnostic possibilities, all bad. I wanted to talk to him, but he couldn’t talk. There was no one who could answer my question. “What happened?”


Slowly, lab work returned.

The only thing out of whack was his serum sodium—124. Normal range is 134-145. Low, but not critically low. Or was it?


Water intoxication happens when a person ingests too much water that does not contain electrolytes or minerals. Sodium is the marker—water is absorbed by the GI tract, going into the blood where it lowers the sodium ion level. When this happens, the body’s cells have higher concentrations of sodium causing water to be pulled into the tissue to equalize the imbalance. The excess water leads to swelling. This is particularly ominous in the brain as swelling produces neurological symptoms. If there is too much swelling the brain shifts inside the skull causing life-threatening consequences.


Treatment involves monitoring of mental status and returning sodium levels to normal in a slow but steady manner. Too rapid correction can itself result in brain injury.


The solution is prevention. Summer is coming. Already in Mesa we have had temperatures in the high 90s. The admonition is to drink enough water. Yes. You should carry water bottles and drink the water.


Insensible water losses cannot be measured—how much you sweat, how much water is in your breath. During exertion and extremely hot weather, insensible loses can be extreme. Staying hydrated means drinking sufficient water, but also replacing the electrolytes lost in sweat.


Symptoms of dehydration include dizziness, fast heat rate, dry skin, fatigue and lack of mental focus. It is good to pair water replenishment with something salty, including electrolyte drinks.


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