A Woman Died After She Drank 40 Glasses of Water!

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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.

Reference:

Farrell DJ, Bower L. Fatal water intoxication. J Clin Pathol. 2003;56(10):803-804. doi:10.1136/jcp.56.10.803-a

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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