Water Intoxication : What do you need to know ?
It is common to have been encouraged to drink as much water as we can to stay healthy and hydrated. This is an example from WebMD. Still, some of our own patients have been passing away due to a high water consumption. Here, you can find an example from a Michigan prison and another from the San Diego Central Jail. Intoxication from water is considered to be an uncommon condition in the US population.
This is also called psychogenic polydipsia (PPD) and has been observed to occur more often in correctional facilities. Nurses in these correctional facilities as well as officers must be aware of this condition and act in a timely manner to keep these incidents from happening.
A few years ago while on a visit to a risk management site, this condition got my attention. A correctional officer stationed in the mental health unit of a prison recounts the story of an inmate who started drinking water without control. The officer suspected that the inmate’s behavior was out of the normal and asked a nurse to look into the issue.
This evaluation had a positive result because the inmate was examined and the resulting PPD was diagnosed early. Regrettably, as can be read in the accounts of intoxication from water in California and Michigan, very often the condition is not diagnosed or overseen as it should be.
What is PPD (Water Intoxication)?
Intoxication from water results from intaking so much fluid to the point that the body can no longer handle it physiologically. This excess of fluid negatively disturbs the balance of electrolytes in the human body by making the level of sodium and plasma osmolality to decrease below what can usually be tolerated by the kidneys. Listed here are some signs of hyponatremia that results from intoxication by drinking too much water:
- Puffiness of the eyes
- Expansion of the abdomen
- Acute edema
- Throwing up
This lack of electrolyte balance also brings about changes in behavior, and these behaviors can be misinterpreted to be part of a mental disorder:
- Anger outbreaks
- Pacing around
Sudden changes of fluids in the brain can cause a coma, seizures and even death. PPD needs to be taken seriously and should be diagnosed on time and treated carefully.
Who is likely to suffer from this condition ?
In both of the cases, the patients suffered from schizophrenia. In fact, about 20 percent of psychiatric patients have this condition. The growing number of mentally ill inmates is an important factor in the number of water intoxication cases in correctional places.
Patients who fit the categories below are also likely to get hyponatremia:
- Ecstasy users (MDMA)
- Athletes (endurance)
- Parenteral nutrition patients
Since it is not common for nurses in correctional facilities to care for patients on TPN, the use of drugs is common among inmates. Sportive competitions among those inmates can get out of control. Most importantly, PPD will result in psychiatric patients.
How is Water Intoxication treated?
Handling intoxication from water is not easy. Some recommendation from psychiatrists Perch and O’Connor can be found.
Avoid judging: In a water intoxication case, drinking too much water is something that will be difficult to control and manage. Gain the patient’s trust by showing no judgement and being sympathetic towards the patient.
Regularly check the patient’s weight: Monitoring the weight every day can give insight on the intake of water. By clicking on the Correctional Nursing Podcast, you will hear how Psychiatrist Scott Eliason uses this intervention in his work with patients in the Idaho Correctional system.
Keep fluids to a minimum but do not eliminate them: Stay hydrated with 2 to 3 liters of fluid. Careful monitoring will be necessary to stay hydrated if a dry cell is used.
Carefully consider psychotropic medication: A psychiatrist might be able to change the medication to ease frequent fluid intake.
Positively reinforce the patient: Patients will benefit more from being treated if they are rewarded for complying with the fluid intake limit.