In the initial stages, the signs and symptoms of water intoxication may be insignificant and resemble some common illnesses. Affected individuals usually vomit, experience headache and also develop certain changes in mental state, characterized by confusion and disorientation [5].

In the advanced stages of the disease, water intoxication can cause the sodium levels to drop dramatically which can lead to weakening of muscles, spasms and muscle cramps. Affected individuals can also experience seizures, followed by state of unconsciousness and finally coma [6] [7].

Infants or babies affected by water intoxication, exhibit signs of inattentiveness, irritability and drowsiness as part of altered mental state. They may also experience difficulty in breathing, muscle cramps and spasms, twitching along with blurred vision. The face of the affected babies may swell, following a slight drop in their body temperature.

• Weakness

  A 50-yr-old Caucasian man, with congenital central DI, developed an episode of generalized tonic-clonic seizure, resulting in coma immediately after being admitted to the Emergency Unit for weakness and emesis. [ncbi.nlm.nih.gov]

  […] induces brain shrinkage, which can tear the cerebral blood vessels, leading to cerebral hemorrhage, seizures, paralysis, and encephalopathy. ( 2 )( 3 ) Infants who have severe hypernatremia (serum sodium, >160 mEq/L [160 mmol/L]) often present with muscle weakness [doi.org]

  Since water will affect the whole body including the digestive and the nervous system, water-intoxicated adults are likely to experience nausea, slurred speech, weakness and fatigue, muscle cramps, headache and bloating, while hallucination, disorientation [ic.steadyhealth.com]

  Symptoms include nausea, vomiting, weakness and, in severe cases, seizures, coma and death. [articles.latimes.com]

  Call your doctor if you know you are at risk of hyponatremia and are experiencing nausea, headaches, cramping or weakness. Depending on the extent and duration of these signs and symptoms, your doctor may recommend seeking immediate medical care. [mayoclinic.org]

• Weight Loss

  Although it was thought that the dilute urine was the result of purposely adding water, the medical evaluation revealed that the patient had chronic water intoxication from a very strict weight loss regimen. [ncbi.nlm.nih.gov]

  The main sign of water intoxication is a sudden weight gain, and sometimes, swelling of the feet. Water intoxication can occur without weight gain and even with moderate weight loss due to dehydration [1]. Diagnosis. [nutrientsreview.com]

  You constantly hear about the importance of drinking plenty of fluids; it's tied to everything from having more energy to weight loss, and it's emphasized even more when people are exercising or are sick. [thrillist.com]

  Individuals who adhere to a strict dietary regime for intentional weight loss, where they are required to consume more water are at an increased risk for developing water intoxication. [symptoma.com]

  Urine output exceeded 6 mL/kg/h over the next 8 hours and was accompanied by a weight loss of 180 g and resolution of edema. [pediatrics.aappublications.org]

• Hypothermia

  This article reports a case of a 3-month-old male presenting with hyponatremic seizure and hypothermia. The presence of marijuana in the infant's urine was remarkable. An etiologic role for the drug is questioned. [ncbi.nlm.nih.gov]

  Physical signs and symptoms can be manifested as difficulty breathing during exertion, muscle weakness and pain, twitching, cramping, dilated pupils, cyanosis, hypothermia, nausea, vomiting and thirst. [backpackingmastery.com]

  Advanced hyponatraemia can be associated with hallucinations, inappropriate behaviour, altered temperature regulation (including hypothermia), seizures, coma, diabetes insipidus and respiratory arrest. [erowid.org]

  DISCUSSION These examples illustrate a well-described spectrum of symptoms that characterize water intoxication, consisting of altered mental status (typically irritability or somnolence), hypothermia, edema, and seizure. 1, 12 Symptoms are preceded by [pediatrics.aappublications.org]

  […] of breathing (in pulmonary edema) or decreased frequency and volume of breathing (in respiratory arrest) Bluish discoloration of the lips and hands (cyanosis due to pulmonary edema) Decreased (hypotension) or increased blood pressure (hypertension) Hypothermia [ehealthstar.com]

• Fever

  Common situations such as extreme heat, significant activity, and illness with fever will all require more fluid intake than average. In a healthy person, your urine is a good indicator of your hydration status. [healthline.com]

  […] sight reaction (including phlebitis) Pyrexia Orthostatic hypotension Tolvaptan [8] Vasopressin V2 receptor antagonist Increase low levels of sodium in the blood Increases amount of water released in urine raising soium levels in blood Thirst Dry mouth Fever [physio-pedia.com]

  The mean body temperature on admission (including 4 infants with fever) was 36.4 ± 1.4°C. Serum sodium levels returned to normal within a mean time interval of 11.3 ± 5.7 hours (mean rate of return 1.6 ± 0.7 mEq/h). [pediatrics.aappublications.org]

• Cough

  […] the blood sodium levels fall below ~105 mmol/L: Muscle cramps, tremor, shaking Swelling of the hands and feet, or abdomen (ascites), especially in alcoholics Drowsiness, blurred vision Confusion, unusual behavior, agitation, hallucinations, delirium Coughing [ehealthstar.com]

• Nausea

  Home British & World English water intoxication water intoxication noun Medicine A condition resulting from excessive water intake or administration, or from impaired water excretion, characterized by headache, nausea, unsteadiness, and confusion, progressing [en.oxforddictionaries.com]

  The condition may go unrecognised in the early stages when the patient may have symptoms of confusion, disorientation, nausea, and vomiting, but also changes in mental state and psychotic symptoms. [doi.org]

  At first, when the intoxication is mild, you may feel light-headedness, dizziness, or nausea. [athleticheartsf.com]

  With more severe cases of hyponatremia, you may need to take medications to offset the feelings of nausea and headaches. [symptomfind.com]

  When the brain is affected, it begins to swell, and symptoms range from confusion to nausea, and in extreme cases, seizures. Without proper treatment, brain stem herniation can occur, which can be fatal. [ahchealthenews.com]

• Diarrhea

  Young infants with vomiting and diarrhea are especially prone to developing hyponatremia if fed fluids lacking sufficient sodium, but even those who are otherwise well may develop symptomatic hyponatremia as a result of being fed excess solute-free water [ncbi.nlm.nih.gov]

  Initial symptoms are mild and can resemble those of diarrhea. Drinking water in the amounts exceeding the body’s requirements is a primary cause of water intoxication, but some antidepressant drugs may also lead to water-poisoning. [ic.steadyhealth.com]

  Hypernatremic dehydration may be caused by pure water loss (diabetes insipidus), hypotonic fluid loss (vomiting or diarrhea), or hypertonic sodium gain (hypertonic feeding preparations such as improperly prepared infant formula). ( 1 ) Severe hypovolemic [doi.org]

  As the electrolyte levels get dangerously out of balance, body systems begin to fail and the sufferer exhibits signs of crisis such as diarrhea, over-salivation, stupor, vomiting, muscle tremors, confusion, frequent urination and other general symptoms [erowid.org]

  Other early symptoms can include diarrhea, nausea, and vomiting. Continued "If you see someone like that, pull them aside, put them in the shade, and talk to them," McStay says. [webmd.com]

• Sweating

  What happens, as perhaps did to the marathoner above, is that they run for hours and sweat out salt – up to 3 grams salt per hour if you are REALLY sweating. [scoobysworkshop.com]

  Moving to or visiting a much hotter climate than you're used to can increase sweating and your risk for an electrolyte imbalance. [symptomfind.com]

• Increased Sweating

  Moving to or visiting a much hotter climate than you're used to can increase sweating and your risk for an electrolyte imbalance. [symptomfind.com]

• Muscle Cramp

  In the advanced stages of the disease, water intoxication can cause the sodium levels to drop dramatically which can lead to weakening of muscles, spasms and muscle cramps. [symptoma.com]

  And excessive fluid intake does not stop fatigue, muscle cramps or heat stroke. [mirror.co.uk]

  Instead, both cramping and heat problems seem to result from athletes pushing themselves too hard. Muscles cramp, Dr. [well.blogs.nytimes.com]

  Since water will affect the whole body including the digestive and the nervous system, water-intoxicated adults are likely to experience nausea, slurred speech, weakness and fatigue, muscle cramps, headache and bloating, while hallucination, disorientation [ic.steadyhealth.com]

  Licensed under CC BY-SA 2.0 via Commons – Some people also may believe that drinking will prevent or treat muscle cramps, and so they may drink more than they need to on that basis. [athleticheartsf.com]

• Muscle Spasm

  In the advanced stages of the disease, water intoxication can cause the sodium levels to drop dramatically which can lead to weakening of muscles, spasms and muscle cramps. [symptoma.com]

  Symptoms The key symptoms of overhydration include: Fatigue Headache Confusion Nausea Vomiting Irritability Restlessness Muscle spasms or cramps Seizures Unconsciousness In severe cases, overhydration can also lead to coma or death, so it is very important [symptomfind.com]

  […] through our muscles and this would cause mild to acute spasms; a sense of weakness when trying to use the muscle; and jolting cramps that can lead to temporary paralysis. [survival-mastery.com]

• Polyuria

  Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI. We present four case reports of WI. [ncbi.nlm.nih.gov]

  We conclude that the incorporation of a vasopressin assay improves accuracy in the differential diagnosis of polyuria. (N Engl J Med. 1981; 305:1539–46.) [doi.org]

• Seizure

  Patient consciousness returned to normal by day 5 after the seizure. In patients treated with desmopressin the risk of a seizure or altered level of consciousness can be minimized by not ingesting large quantities of fluid. [ncbi.nlm.nih.gov]

• Headache

  Natural remedies to relieve a headache Wed, August 31, 2016 Cure your headache naturally with these home remedies. [express.co.uk]

  The acute drop in serum osmolality leads to cerebral edema, causing headaches, confusion, seizures, and death. [ncbi.nlm.nih.gov]

  Customer: Right Anthony Bray, MD : If you have severe headache or neurological symptoms then go to ER.... [justanswer.com]

• Confusion

  As the sodium concentration falls, the symptoms progress from confusion to drowsiness and eventually coma. [doi.org]

  The acute drop in serum osmolality leads to cerebral edema, causing headaches, confusion, seizures, and death. [ncbi.nlm.nih.gov]

  The most common symptoms of the condition in small children are confusion, fatigue and headache, but bodily temperature may decrease slightly as well, and the baby can become irritable or sleepy. [ic.steadyhealth.com]

• Convulsions

  Additionally, elevated ADH concentrations have been reported in epileptic patients showing frequent convulsions [ 9 ], and the expression of vasopressin mRNA is up-regulated by convulsions in rats [ 10 ]. [karger.com]

  On August 3, 1992, the coma following a convulsion occurred. Laboratory data initially showed marked hyponatremia and hypochloremia with decreased serum potassium, and a gradual increase in serum creatine phosphokinase (CPK). [ncbi.nlm.nih.gov]

  Symptoms of delirium and convulsions induced in a healthy person by the voluntary ingestion of excess water have been recorded in the literature only once. [nejm.org]

• Irritability

  The most common symptoms of the condition in small children are confusion, fatigue and headache, but bodily temperature may decrease slightly as well, and the baby can become irritable or sleepy. [ic.steadyhealth.com]

  Losing sodium can affect brain activity, so early symptoms of water intoxication can include irritability, drowsiness and other mental changes. [reuters.com]

  Infants or babies affected by water intoxication, exhibit signs of inattentiveness, irritability and drowsiness as part of altered mental state. [symptoma.com]

  If your baby exhibits any of the following symptoms, it is important to contact your pediatrician immediately: Swollen face Body temp below 97 degrees Fahrenheit Unusual irritability Unusual drowsiness As was mentioned above, too much water in the baby's [baby.lovetoknow.com]

A past medical history about disease and drug profile will be gathered, followed by physical examination of signs and symptoms. However, physical examination alone would not be sufficient to diagnose the condition of hyponatremia that has occurred due to water intoxication. Therefore, a complete blood profile along with urine tests to determine the levels of sodium level would be required.

Blood tests to assess drug intoxication and underlying disease conditions such as diabetes would also form an important part of diagnostic procedure. Along with this, mental health screening for determining presence of psychiatric illness is also indicated [8].

• Plasma Volume Increased

  It reduces plasma volume, increases heart rate (HR) decreases blood flow to the skin, sweating and heat dissipation is reduced and body temperature increases by 1o C, and when it reaches 39o C, performance fell drastically by a malfunction of energy production [scielo.isciii.es]

• Hyponatremia

  Water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excess perioperative water consumption. [ncbi.nlm.nih.gov]

• Hypochloremia

  Laboratory data initially showed marked hyponatremia and hypochloremia with decreased serum potassium, and a gradual increase in serum creatine phosphokinase (CPK). [ncbi.nlm.nih.gov]

• Hypouricemia

  This finding, taken together with the patient's decreased free water clearance, inhibition of the renin-aldosterone system and hypouricemia with elevated uric acid clearance led us to make a tentative diagnosis as secondary SIADH, and the diagnosis was [karger.com]

In the initial stages, restricting fluid intake forms the basis of treatment regime in order to correct hyponatremia. This is followed by treating underlying disease conditions. The patient would also be put on diuretics in order to improve the sodium levels. In more severe cases, hospitalization would be indicated. Intravenous administration of sodium is indicated to increase the serum sodium levels. Medications would also be required to effectively manage the symptoms associated with water intoxication [9].

Prognosis of patients suffering from water intoxication is fairly good if the condition is promptly treated when the first signs and symptoms appear. However, delay in initiation of treatment can call for irreversible damage to set in and eventually cause death.

Excessive consumption of water knowingly or unknowingly can cause overhydration to set in. Certain medications can increase the thirst in individuals which can eventually cause an increased consumption of water. Increase in thirst mechanism can also be an indication of some underlying disease condition such as diabetes. Psychiatric illnesses can also lead to compulsive drinking of water. In addition, other risk factors for water intoxication include low body mass in infants, heat stress or overexertion, iatrogenic and drinking water for some sort of competition. Individuals who adhere to a strict dietary regime for intentional weight loss, where they are required to consume more water are at an increased risk for developing water intoxication [2] [3].

According to various research studies carried out across the globe, it was reported that water intoxication can be a significant cause of mortality amongst patients suffering from schizophrenia. Of 353 patients under a study, about 38 were found to be polydipsic and one third of them was at an increased risk of water intoxication.

In the condition of water intoxication, the electrolyte content in the fluid outside the cells is extremely low in contrast to what is present inside the cells. Such a kind of phenomenon causes the fluid to shift, in order to balance the concentration. This in turn causes the cells to swell, which eventually increases the intracranial pressure. This is what gives rise to the preliminary signs and symptoms of water intoxication. If the condition is not corrected, then the brain cells further undergo swelling giving rise to cerebral edema which occurs due to interruption in blood flow [4].

Individuals are advised against drinking more than 1 litre of water per hour. Appropriate hydration prior to participating in race or any other strenuous activities can also help prevent excessive drinking of water. Athletes are also advised to sip in sports beverages containing sodium and potassium. These would help replenish the lost electrolytes. Individuals are also advised to consult doctor if they experience a strong desire to drink water or are excessively thirsty [10].

The condition is also termed as dilutional hyponatremia. Just like any other substance, water too can turn poisonous for the body if consumed beyond limits. It has been estimated that majority of death that have occurred due to water intoxication have resulted from excessive consumption of water by individuals who are either participating in contests or by athletes who after heavy exercise have consumed large amounts of water [1].

• Definition: Water intoxication occurs when there is excessive consumption of water either knowingly or unknowingly. The condition can really turn fatal if treatment is not initiated on time. Various complications of water intoxication include onset of cerebral edema and death in many cases. Individuals suffering from underlying disease condition such as diabetes or psychiatric illnesses are at an increased risk of water intoxication.
• Cause: Excessive consumption of water in a short period of time can lead to water intoxication. Underlying disease conditions can increase the urge to drink water which can lead to onset of water intoxication. In addition, other factors include medications such as diuretics, disease conditions such as hypothyroidism, dehydration, kidney and heart diseases.
• Symptoms: Preliminary symptoms of water intoxication include headache, vomiting, slurred speech, feeling of restlessness and bloating. In severe cases, individuals may also develop seizures, muscle cramps and can even enter the comatose stage.
• Diagnosis: Physical examination of the signs and symptoms is done at the preliminary level. In addition, blood tests and urine analysis are required to determine the levels of sodium. These tests are also required for evaluating underlying disease conditions that is causing hyponatremia.
• Treatment: Treatment of water intoxication is carried out by restricting the fluid intake in the initial levels. This is followed by administration of diuretics to increase the sodium concentration. In severe cases, hospitalization would be required to administer sodium intravenously.

1. Adrogué HJ, Madias NE.The challenge of hyponatremia. J Am SocNephrol 2012; 23:1140.
2. vLanggard H, Smith WO. Self-induced water intoxication without predisposing illness. N Engl J Med 1964;266:378–381.
3. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000; 342:1581.
4. Ayus JC, Varon J, Arieff AI. Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med 2000; 132:711.
5. Sterns RH, Ocdol H, Schrier RW, et al. Hyponatremia: Pathophysiology, diagnosis, and therapy, in Narins RG (ed): Maxwell &Kleeman's Clinical Disorders of Fluid and Electrolyte Metabolism. New York, McGraw- Hill Health Professions Division, 1994, ed 5, pp 590–599.
6. Halawa I, Andersson T, Tomson T. Hyponatremia and risk of seizures: a retrospective cross-sectional study. Epilepsia 2011; 52:410.
7. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome. A study of 64 cases. Ann Intern Med 1987; 107:656.
8. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013; 126:S1.
9. Soupart A, Decaux G. Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. ClinNephrol 1996; 46:149.
10. Ayus JC, Arieff A, Moritz ML. Hyponatremia in marathon runners. N Engl J Med 2005; 353:427.