Dr. Erika Kube: Is there such a thing as drinking too much water? – The Columbus Dispatch

Dr. Erika Kube: Is there such a thing as drinking too much water?  The Columbus Dispatch

Jeff came to the emergency department via ambulance with slurred speech and altered mental status. The paramedics were called to his home by his wife, who found him in the bathroom confused. When he didn’t come out, she went into the bathroom to check on him and found him standing at the sink with the water running. She asked if he was OK and immediately realized something was wrong. He seemed startled to see her and didn’t understand what she was saying. When he finally spoke, his speech was slurred and he was disoriented.

Jeff’s wife, Susan, ran to get her cellphone and called 911. She took Jeff’s hand and led him into the living room where she motioned for him to sit on the couch. He did not have any difficulty walking. She sat with him on the couch while they waited for paramedics. When the medics arrived, they quickly assessed Jeff, put him on a monitor and checked his blood sugar, which was normal.

Susan kept talking to and reassuring her husband, who was extremely confused. The paramedics evaluated Jeff for a stroke by assessing him for facial droop, weakness of extremities, and grip strength. He did well on all the tests and showed no signs of a stroke. The medics transported Jeff to the emergency department (ED) where I met the ambulance to quickly evaluate and try to figure out what was going on with him. He slurred his speech at times, but didn’t have any weakness in his arms or legs. His symptoms seemed to wax and wane. The nurse drew blood from his IV and I ordered a CT scan of Jeff’s brain.

Susan arrived in the ED while Jeff was getting his CT scan done. She said Jeff had no medical problems and never had anything like this happen to him. She said he didn’t drink alcohol or use drugs. He also didn’t take any home medications. The only thing different in the past few days was he had done the preparation work for his colonoscopy, which was scheduled for the next day. She said he had adhered to the liquid-only diet, had taken his laxatives and completed the solution that he had to drink. Susan said Jeff told her that he was “all cleaned out” and ready for his colonoscopy.

She also told me that he had repeatedly told her how thirsty he was and that he had been drinking a lot of water once he finished his bowel prep solution. As we were wrapping up our conversation Jeff came back from the scan and Susan immediately held his hand. He seemed reassured by her presence.

Jeff’s CT scan results came back quickly and showed no abnormalities. But the lab technician called to report that Jeff’s sodium level was very low. The rest of his blood work was normal. I was interested in hearing more about what Jeff had been drinking over the past few days. He seemed more oriented now, but Susan still had to answer most questions for him. He had completed his jug of bowel preparation over the recommended time with good results. After that he started drinking a lot of water. She had cleaned up numerous empty water bottles near the couch and next to the bed. Despite how much he drank, he said he still felt thirsty.

I realized then that Jeff’s confusion and slurred speech was due to hyponatremia, which occurs when the level of sodium in the blood is too low. The condition can lead to swelling of the brain, which can cause confusion, nausea, vomiting, headache, seizures, coma, and even death. Hyponatremia is frequently associated with prolonged exercise and sweating but can also occur with excessive water drinking, which was the case for Jeff. Cases of hyponatremia have been seen in long distance runners and extreme athletes, which is why there are so many electrolyte replacement products like Gatorade. It’s uncommon for people to get the condition while preparing for their colonoscopy but it has happened.

To treat Jeff’s hyponatremia, I gave him a slow rate of saline, which contains sodium, through his IV and restricted his oral fluid intake. Correcting the sodium level too quickly can have serious consequences, so it must be done slowly. Jeff was hospitalized and as his sodium level became more normal, so did his mental status. He was completely back to himself when he went home a few days later. He had to reschedule his colonoscopy and planned to hydrate with Gatorade and be cautious about how much water he drank next time.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.