A 64-year-old woman died after she drank 40 glasses of water in one evening. Cause of death confirmed on autopsy!
A post-mortem examination was carried out on a 64-year-old deceased female who died after drinking 40 glasses of water. The deceased was a known case of mitral valve disease. The rest of the history was unremarkable. A day before her death, since evening she started drinking water compulsively in vast quantities. She drank almost 40 glasses of water. In between drinking water she also vomited multiple times.
Soon after excessive consumption of water along with episodes of vomiting, she became distressed and hysterical. However, she refused medical help. Instead, she yelled that she hadn’t drunk enough and wanted more water. She continued drinking water until she went to bed. Later she died in her sleep.
Around 6 hours later, the deceased underwent a post-mortem examination. The autopsy revealed normal pituitary and adrenal glands. Moreover, it did not reveal any evidence of bronchial tumour. However, examination showed bilateral pleural effusions of 200 ml. additionally, the cut surfaces of the lungs (568 g and 441 g) exuded frothy pink fluid.
Autopsy of the heart showed mitral valve disease and left ventricular hypertrophy. The stomach contained 800 ml of watery fluid. The intra-abdominal organs were overall wet.
Post-mortem toxicology was negative.
Vitreous humour had a decreased sodium concentration of 92 mmol/litre (serum reference range, 132–144). Rest of the tests were normal including normal levels of potassium, urea, and glucose.
However, serum cortisol was elevated, therefore, it excluded Addisonian crisis.
The post-mortem examination concluded that hyponatraemia was the cause of death. Hyponatremia was secondary to acute water intoxication.
Although the serum sodium concentration after death may not be suitable for measurement, the sodium concentration in the vitreous humour is stable during the early post-mortem period.
Excessive water intake or water intoxication can lead to electrolyte imbalances. For example, acute water intoxication leads to a rapid decline in the serum sodium concentration. The latter can lead to death since acute dilutional hyponatraemia leads to swelling of the brain cells as the water moves into the cells. Consequently, neurological symptoms develop and it may lead to death too.
Patients usually become symptomatic when the serum sodium concentration falls below 110 mmol/litre, in some cases even below 120 mmol/litre. Symptoms progress as the serum sodium concentration decreases. Patients may experience nausea, vomiting and neurological symptoms including confusion, seizures, drowsiness, coma and even death.
Early detection and correct management are crucial in saving a life. A rapid correction of sodium can also lead to fatal complications; therefore, it is imperative to be aware of the diagnosis and the management guidelines while treating a patient with hyponatremia.
Farrell DJ, Bower L. Fatal water intoxication. J Clin Pathol. 2003;56(10):803-804. doi:10.1136/jcp.56.10.803-a