The Dangers of Drinking Too Much Water

This study aims to prove that taking excessive amounts of water will cause water intoxication. Hyponatremia is a body condition in which the body takes in too much water, causing dilution of the blood’s sodium content. Low sodium levels in the body cause rapid and severe swelling of the brain that causes other reactions such as coma, seizures, and death. Excessive water drinking is a crucial risk aspect for hyponatremia, but there are possibilities for excessive sweating leading to significant sodium losses. In a state of hyponatremia, the fluid-electrolyte balance has an abnormally low plasma sodium concentration of below 135mmol/liter. The serum osmolality is calculated by the concentration in millimoles per liter of the significant serum solutes according to the following equation (Murray et al.2005). 

Sosm (mmol/liter) = (2*serum [Na] + (serum [glucose]/18) + (blood urea nitrogen /2.8). 

The consistent reduction in the plasma sodium concentration causes an osmotic imbalance across the blood-brain barrier, causing a transportation of water into the brain. The influx subsequently causes brain swelling and several other severe neurological responses. As the t blood sodium falls and its reduction increases, the greater the risk of death or stroke. When the sodium concentration reduces to 125-135 mmol/liter, the symptoms are usually not noticeable or relatively modest, with the patient experiences gastrointestinal disturbances such as mild nausea or bloating (Murray et al, 2005). The symptoms that occur when the concentration drops below 125mmol/liter are more severe and include severe migraines, nausea, shortness of breath, hand and feet swelling, anxiousness, confusion and abnormal tiredness. At below 120mmol sodium concentration, an individual will experience seizures, respiratory arrests, comas, irreversible brain damage, and loss of life becomes more likely. Athletes are most likely to develop acute hyponatremia due to their over hydration associated with the anti-diuretic hormone's persistent secretion. Alcohol drinkers and patients with low-protein and high water intake diets have a reduced water excretory capacity and a suppressed anti-diuretic hormone. This results in very poor protein breakdown and urea excretion of less than 250mosmol. Hyponatremia occurs if the daily fluid intake is more than four l/day. 

Clinicians are advised to note the drug and diet history, history of volume loss such as diarrhea to help diagnose hyponatremia. Also, the determination of volume statuses such as dehydration, edema, and ascites should be carried out before diagnosis. A detailed investigation includes measuring serum sodium, serum osmolality, and urine osmolality, which will be carried out on this research sample. If the urine ratio to serum electrolyte is below 0.5, there is a high urine electrolyte free water, and the restriction is adequate. On the other hand, if the ratio is more significant than one, the urine is hypertonic compared to the serum water restriction is not sufficient, and measures need to be taken to correct hyponatremia. 

This study is designed to evaluate the role of over hydration in reducing osmotic activity caused by the dilution of sodium in the body. Daily injections of Pitressin Tarnate in Oil will be used to induce overhydration and marked hyponatremia while maintaining strict balance conditions. The study will also confirm the causes of severe hyponatremia and water intoxication. 

Research Question 

My research topic focuses on health and wellness. The objective is to study whether drinking excess water can be fatal to your health. The research question that would be investigated further is whether consuming excess water may cause intoxication and death. The primary disorder is hyponatremia. 

Theoretical framework 

The hyponatremia condition may go unnoticed, mainly when it results in an individual's death with no prior clinical history or postmortem investigations. Therefore, clinicians and pathologists are advised to become aware of the water intoxication effects, diagnosis, and medication. Medical scientists prescribe medications against common water drinking disorders such as rhabdomyolysis, compulsive drinking disorder, and hyponatremia. However, when the symptoms are evaluated early enough, physicians can treat water intoxication and its related disorders by providing sodium to return body fluid osmotic balance and cutting fluid intake. 

Therefore, the two significant operational variables in the research study are water as the independent variable which the Pitressin injection will induce. The dependent variable is whether over hydration induced by the Pitressin will cause hyponatremia. Using this information, I can develop the hypothesis for the study. 

Hypothesis 

The identified independent variable in my research study would raise testable speculations of the following nature; 

Null hypothesis: Drinking abundant water does not cause water intoxication to the body. 

Based on limited literature, the alternative hypothesis is Intake of large quantities of water causes water intoxication to the body. 

Ethics Statement 

This study will be carried out at one center in accordance to the ethical principles formulated during the Declaration of Helsinki and afterwards seek an approval by an Independent Ethics Committee, Comité de Protection des Personnes Est IV, located in Strasbourg (Sahay &Shay,2014). We will seek protocol approval by the institutional review board of the French Drug Agency, Agence Nationale de Sécurité du Médicament de Santé, before carrying out the research. All participants will be asked to provide written informed consent. 

Population and Sample. 

This retrospective study will be carried out in a metabolism ward of a medical center. Data from the medical records of ten patients admitted to the metabolism ward will be used, while additional information will be collected from the tests carried out during the study. The patients to participate will be randomly sampled. There will be five female participants and five male participants. The subjects will be of different ages depending on how many will be willing to participate in the study. The participating patients will be chosen based on their willingness to participate in the study. All the risks involved will be revealed to them. Exclusion criteria will be based on the following 

Patients who will not be admitted 

Patients who will be discharged or transferred to another health facility within twenty fours of admission; 

Patients who have been diagnosed with chronic heart failure, liver cirrhosis, or chronic kidney disease. 

Variables and Measures. 

Thirteen balance studies will be conducted on the patients. Each patient will be placed in a separate, temperature-controlled room. A constant diet will be administered with the constituents being recorded in a table with the following details: 

Study

Patient

Age

sex,

diagnosis

Initial  Weight  Kg

Sodium  Na (mEq.)

Potassium  K (mEq.)

Nitrogen  (Gm.)

Water  H20 (liters)

Calories

All excreta will be collected quantitatively, and stool collections separated into periods with carmine markers. The population sample will also be weighed at the end of each 24 hours. A fasting blood sample will also be drawn from the patients with no exposure to air. Specially trained nurses and physicians will observe the patients throughout the day and night to ensure an accurate report of the symptoms. After adjusting a constant diet, a control period of three days will start. The control period will be followed by a treatment period during which one or two Pitressin units will be injected daily. In cases where over hydration needs to be reduced, the injection of Pitressin will continue but with an infusion of between 10-12.5 percent mannitol. 

Sodium and Potassium will be analyzed on an internal-standard flame photometer, while chloride will be analyzed using an automatic titration with a Cotlove chloridimeter. Nitrogen will be analyzed using the macro-Kjeldahl method, osmolality using freezing point depression, calcium using an established method, and the potassium balance will be corrected for nitrogen balance. In this study, an assumption of an insensible loss of 5 mEq. /day for sodium, Potassium, and chloride will be made regardless of whether there will be visible sweat or not. The initial total body weight will be assumed to be 60% of the body weight. The estimation of adrenal function will be done by measuring urine hydroxyl-steroid excretion. The values for total body osmotically active cation, the change in the osmotically active cation unaccounted for by electrolyte balance, and changes in serum sodium concentration predicted by water and electrolyte balance will be estimated using observed serum sodium concentration, sodium, and Potassium balance and calculated total body water values. Isotonicity among body fluid compartments will be assumed, while the serum sodium will be used as an arbitrary point to calculated the cation balance for use in the calculation of the osmotic changes. The key variables to be analyzed are the renal concentrating ability, the change in electrolyte concentration and distribution, and the correlation between the corrected serum sodium concentration and serum osmolality. The renal concentrating ability will be estimated by the U/P osmolar ratio will be determined using 24-hour urine samples and by net solute-free water reabsorption. The population sample will be fast and will receive 20ml/Kg distilled water orally one hour before the infusion. In the cases where the Pitressin injection will lead to hyponatremia, the Pitressin will be discontinued and the water diuresis allowed (Stormont & Waterhouse,1961). If the physician chooses to continue Pitressin administration, reversing the condition will induce intravenous hypertonic mannitol. Additional data for this study will be derived from previous reports that are in the same range as data from this study. 

Data Collection Methods 

Primary data will be collected for this research from the participating patients. The data collected will be quantitative. Structured observation and experiment will be the primary data collection methods for this study. For graphic representation, symptoms of water intoxication were graded as follows: Grade I, mild (lethargy, drowsiness, malaise, fatigue, nervousness, bloated feeling, weakness, and headaches). Grade II, moderate (anorexia, epigastric "hunger pains," nausea, frequent stools, abdominal cramps, tightness of the chest, minimal vomiting). Grade III, severe (haggard appearance, diarrhea, delirium, marked nausea with vomiting). Severe coma or convulsions were not observed. There was no marked change in blood pressure in any subject. 

Data Analysis Methods 

Descriptive statistics will be calculated for all interest variables such as age, sex, baseline body weight, body mass index. Continuous variables will be reported as mean, medians, and interquartile ranges, and categorical variables are presented using counts and percentages. The univariate analysis will be performed using Fisher’s exact test or chi-square test, as appropriate, for binary variables and Mann-Whitney  U  test for continuous and ordinal variables to compare the two groups. The relationship between sodium balance and body weight change will be estimated using the Pearson correlation coefficient. Correlation between corrected serum sodium concentration and serum osmolality will be assessed using Spearman’s rank correlation coefficient and simple linear regression analysis. Multivariate logistic regression analysis for renal concentrating ability will be conducted to adjust predetermined potential confounders such as age and sex. For the sensitivity analysis, multivariate logistic regression analysis was performed similarly, using the serum sodium correction and serum osmolality rates. Also, the receiver operating characteristic (ROC) curve was described, and the area under the curve (AUC) was calculated to estimate the predictive values of the serum sodium correction rate. The cutoff point will be determined to maximize the predictive power of Youden’s index. All the p  values in this research will be two-tailed, and  p  values <0.05 will have a statistical significance. Statistical analysis will be performed using IBM SPSS for Mac Version 22.0 (IBM Corp., Armonk, NY) 

References 

Murray, B., Stofan, J., & Steichner, E. (2005).  Hyponatremia in Athletes . Gatorade Sports Science Institute. Retrieved 11 April 2021, from https://www.gssiweb.org/sports-science-exchange/article/sse-88-hyponatremia-in-athletes#articleTopic_3 . 

  Sahay, M., & Sahay, R. (2014). Hyponatremia: A practical approach.  Indian Journal Of Endocrinology And Metabolism ,  18 (6), 760. https://doi.org/10.4103/2230-8210.141320 

STORMONT, J., & WATERHOUSE, C. (1961). The Genesis of Hyponatremia Associated with Marked Overhydration and Water Intoxication.  Circulation ,  24 (2), 191-203. https://doi.org/10.1161/01.cir.24.2.191