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When too much water can kill you

We all know that water is the stuff of life. In the middle of a Rogue Valley summer, we are all too aware of the importance of it. But as with so many things, it is becoming more and more evident that too much can be just as dangerous as not having enough.

In a startling headline some months ago, a radio contest turned deadly when a woman left the contest after drinking approximately two gallons of water over a very short period of time. Only hours later, she was found dead in her home. The cause of death was hyponatremia, sometimes referred to as water intoxication.

Drinking too much water has an effect on the delicate electrolyte balance of the blood stream, particularly sodium levels. When sodium concentration levels get too low, the body's organs, particularly the brain, start to swell and cannot function properly. "Obviously, it can be very serious," says Dr. Dean Raniele of Renal Care Consultants in Medford. "Forcing that amount of water in a short period of time can be dangerous." When the kidneys in particular are "overloaded" because of either impaired function or excessive water intake, the resultant imbalance can have serious consequences.

While headlines link hyponatremia most often to extreme situations like hazings, contests or marathons, it is actually most common in the elderly. "As you grow older, your body changes the way it handles sodium," says Dr. Noriecel Mendoza of Rogue Endocrinology & Metabolic Clinic in Medford. And underlying health conditions, including untreated low thyroid, hormone issues, adrenal insufficiency, poor kidney function, pituitary function or extended use of certain medications (both prescription and illegal), can contribute to depleted sodium levels. It's a balancing act that makes proper medical attention

essential. When the contributing health issue is being properly treated, the chance of hyponatremia becomes much lower.

How much water should you drink? That may depend on your size, activity level and any medical conditions you have, so beware of fixed formulas. Discuss it with your health professional, especially if you're planning on starting any rigorous exercise routines.

The real risk of hyponatremia is when there's a sudden drop in the blood sodium ratio. "It has to do with how low it goes and how rapidly it drops," clarifies Raniele. A change in blood sodium over weeks will not have the same devastating results as one that occurs in a few hours. Mendoza agrees. "Normally you adjust to the change," she says, but a sudden drop may result in weakness, headache, dizziness, and nausea and can progress to seizures, coma and death as the brain and other organs swell due to low blood sodium levels. And the degree of change can be key in identifying the problem, particularly in the elderly. Unlike the slow progress of a disease like Alzheimer's, "[sudden] confusion is a big thing," says Mendoza that may be indicative of an abrupt change in sodium levels.

Along with seniors, it has been suggested that amateur athletes are also at special risk, particularly when entering extended physical events. "They are the ones that get into trouble," says Mendoza. So are there preventative steps that athletes both young and old can take when preparing for a big event?

First and foremost, be sure your health is being properly monitored through routine health care to identify any contributing physical factors. And adequate training will reduce the impact of sodium level shifts in your bloodstream, advises Mendoza. In any strenuous physical event, she also recommends sports drinks that have the proper electrolyte balance to ensure more sodium is added to the blood levels along with the fluids. Remember that sodium is excreted along with water as you sweat and try not to take in more fluid than you are putting out in sweat and urine.

If you suspect hyponatremia in yourself or someone else, do not drink water or recommend water, and because of the risk of seizure, Raniele advises seeking immediate medical attention. The good news is that a simple and very common blood test can check blood sodium levels so that treatment can begin quickly. Be aware and then be assured, Raniele reminds, that "most people living with adequate water intake will never run into trouble."

When too much water can kill you