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Question of the Week

March 15, 2005

Hello!

Last month (February 2005), a college student died after drinking too much ... water.

"A Chico fraternity pledge died of water poisoning, authorities said Thursday as experts warned that the dangerous hazing ritual has killed at least one other person as fraternities are replacing alcohol bingeing with excessive water-drinking. ... Water bingeing is becoming an increasingly common hazing ritual, especially inside rogue frat houses such as Chi Tau, said Hank Nuwer of Indiana, a national expert on hazing and author of four books on the topic. ... '[T]hey think water is safer than alcohol, but it can also be deadly.' Forced water consumption and heavy exercise are known to dilute the salt content of blood to the point where it interferes with brain, heart and muscle function. Without enough sodium, the brain swells and victims can suffer fatal comas.... "
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/02/04/BAGNSB576121.DTL

This is not an isolated incident.

"In March 2003, State University of New York freshman Walter Dean Jennings III was pledging a renegade fraternity that had also been expelled over drinking violations. He was forced to drink so many pitchers of water through a funnel that the sodium in his body dropped to lethal levels and his brain swelled. The autopsy confirmed he died of hyponatremia."
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/02/04/BAGNSB576121.DTL

And then there are incidents of the other extreme:

"The Interfraternity Council late Monday night unanimously voted to withdraw its recognition of the Sigma Chi fraternity following the alleged hazing of a pledge who was hospitalized for kidney failure. ... Greek Life Assistant Director John Duncan said the student and seven other members of his pledge class were 'not given much food or water and they had to do an extensive amount of exercise for an extended period of time.' Sometime after the initiation, the student, a Kinesiology junior and Ann Arbor resident, reported the incident to his family, who drove him to a nearby hospital. He was admitted Sept. 14 [2003] with muscle breakdown, which led to acute renal failure. ... The student was released from the hospital Sept. 19. University officials said he is still recovering."
http://www.michigandaily.com/vnews/display.v/ART/2003/09/24/3f7121d4cba5

Even for those who might not be aware that drinking too much water can be a health concern, drinking too little -- especially when exercising for an extended period of time -- is something that most, if not all, of us have been cautioned to avoid at some point in our lives.

"For years, runners have been told repeatedly that it's a good thing to drink -- and to drink often. Now it appears there can be too much of a good thing. To be sure, dehydration is not to be ignored. You should still consume plenty of sports drinks. But drinking large amounts of water can spell trouble. When you saturate your body with water, you can develop a life-threatening condition known as hyponatremia, a shortage of sodium in the blood. It occurs when runners sweat excessively, lose too much salt, and then drink excessive amounts of water -- which dilutes the blood's sodium content even more. This imbalance can cause fatigue, weakness, cramping, nausea, vomiting, bloating and puffiness in the face and fingers, dizziness, headache, confusion, fainting and unconsciousness, pulmonary edema (fluid in the lungs), seizures, coma -- and sometimes even death."
http://www.runnersworld.com/article/0,5033,s6-78-79-0-438,00.html

Even if you are not planning to join a fraternity, or the track team, any time soon, you still make choices about what you eat and drink each day.

"Though uncommon, it's possible to drink too much water. Drinking excessive amounts can overwhelm your kidneys' ability to get rid of the water. This can lead to hyponatremia, a condition in which excess water intake dilutes the normal amount of sodium in the blood. People who are older, who have certain medical conditions such as congestive heart failure and cirrhosis, or who are taking certain diuretics are at higher risk of hyponatremia."
http://www.mayoclinic.com/invoke.cfm?id=NU00283

Diuretics?

"Diuretics ... These drugs act on the kidneys to increase urine output. This reduces the amount of fluid in the bloodstream, which in turn lowers blood pressure."
http://www.chclibrary.org/micromed/00045620.html

So, you don't take any medications, and you don't have any health conditions that could be possible risk factors. If you are eating on the go throughout the day, you should be aware that:

"Of note, people whose diets include a high intake of fluids and much reduced protein and sodium are at risk for hyponatremia, which can cause fatigue, confusion, dizziness, and in extreme cases, coma."
http://www.umm.edu/patiented/articles/what_weight_control_dietary_approaches_type_2_diabetes_000042_4.htm

Or, the other extreme:

"[T]he significant weight loss proclaimed by dieters eating high fat high protein diets [ketogenic diets] is mainly due to excessive dehydration. This excessive load placed on the kidneys increases fluid loss coupled with glycogen depletion accounting for significant weight loss from water! In addition, the reduced carbohydrate intake will influence protein catabolism. Losses of lean tissue are eminent due to the need of the body to recruit amino acids for the maintenance of body glucose (gluconeogenesis). ... Implications for the active individual are even more severe. Since carbohydrates are the body's primary provider of energy for activity, the end result is a decrease in ability to train and compete. When compared to a well-balanced calorie restricted diet, the ketogenic diet offers no advantages in facilitating weight loss. On the contrary the ketogenic diet does offer; raised serum uric acid levels, altered electrolyte concentrations - linked with cardiac arrhythmias, acidosis, aggravated kidney problems, elevated blood lipids, depleted glycogen storage reserves, and dehydration."
http://www.ncsf.org/tools/articles/articles-20.aspx

Ketogenic diets?

"ketone: a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. High levels of ketones can lead to diabetic ketoacidosis and coma. Sometimes referred to as ketone bodies."
http://diabetes.niddk.nih.gov/dm/pubs/dictionary/K-O.htm

With all this talk about hyponatremia, and even dehydration, there should at least be mention of hypernatremia...

"Hypernatremia is high sodium in the blood that occurs with excessive fluid loss. When fluid is lost and not replaced, sodium is not adequately excreted from the body. The following are causes: Diabetes insipidus (caused by deficiency of or insensitivity to ADH), Diarrhea, Diuretic medication, Excessive salt intake. Excessive vomiting, Heavy respiration (e.g., exercise, exertion), Severe burn, Sweating. It is associated with the same symptoms as hyponatremia, and also causes the following: Delerium, Irritability, Muscle twitching..."
http://www.nephrologychannel.com/electrolytes/hypernatremia.shtml

Those involved with hazing were trying to make things safer, or trying to get around alcohol regulations, or maybe both. For years, those exercising or participating in sports have been told to be sure to drink enough water. Dieters have also been told to drink more water to help them lose weight. We have heard about the risks of drinking too little water, but rarely do we hear about the risks of drinking too much.

Questions of the Week:
Now that you know about hyponatremia, how can you avoid it? What would cause you to tell a friend about it? What should your friends and peers know about this rare, but life-threatening condition? What groups of people do you think are most at risk? How can people avoid dehydration while not putting themselves at risk for hyponatremia?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Cindy
aehealth@yahoo.com
Health Community Coordinator
Access Excellence @ the National Health Museum
http://www.accessexcellence.org

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