Medical professionals having problems with “prescribing” water and clarifying the dosage

Medical Research.

Most of us have heard the saying “too much of a good thing” used to reference excesses in things like chocolate or sex.  Now it seems that this age-old saying may apply to something as innocuous as drinking water.  Hyponatremia is a condition that is defined as a severe electrolyte imbalance which rapidly decreases the sodium in the blood and can have serious consequences and may be fatal.  Hyponatremia, more commonly known as “water intoxication,” is generally caused by drinking too much water within a short period of time.  Early onset symptoms of water intoxication can include: nausea, vomiting, and disorientation.  If the condition is not treated promptly the symptoms generally worsen to include: seizures, coma, brain damage, and death.

Several incidents of water intoxication have been reported, especially in the sports world.  Exercise associated hyponatremia is seen when those engaging in endurance sports and athletic activities “preload” water and sports drinks in order to avoid fatigue, muscle cramps, or heat stroke.  Water intoxication has also been seen in people who use certain recreational drugs such as MDMA because it causes excessive thirst.  Recently, a 59-year old woman in England was admitted to the hospital with water intoxication.  Upon receiving advice to drink more water to treat a urinary tract infection, she drank copious amounts of water and became seriously ill.  Another story involves a woman in California who died after drinking excessive amounts of water to win a radio contest.  Water intoxication happens enough to raise questions amongst medical professionals as to how much water to “prescribe” to patients.

The above mentioned 59-year old English patient prompted a recent case report in the British Medical Journal, which states that healthcare professionals generally advice patients to “drink more fluids” when sick.  This can be a gray area as there are no standard guidelines for the dosage of water.  Perhaps there is a need for more clarity and formal measurements regarding the prescription of water.  Less ambiguity in this regard could help avoid any costly misinterpretation by patients and remit medical professionals of liability.

It may be difficult to clearly quantify the amount of water appropriate for any given individual when so many factors need to be taken into account.  The prevailing rule of thumb is 8 glasses of water a day, or to drink when thirsty.  However, there is no range stated to account for a person’s lifestyle and environment.  A standard chart using a persons weight and height would also need to account for a person’s activity level and environmental factors, such as altitude and temperature.

The British Medical Journal case report by doctors Laura Christine Lee and Maryann Noronha, concluded that more research should be done to clarify the common advice of “drink more fluids” given to patients.  The onus lies somewhere between individual responsibility and more clarity from the medical community.  The phrases “drink plenty of water” and “stay hydrated” do not seem precise enough in today’s environment of scientific accuracy.  


The British Medical Journal
BMJ Case Reports 2016; doi: 10.1136/bcr-2016-216882
“Drinking too much water can be deadly, doctors warn” – Lucy Pasha-Robinson
“Woman dies after water-drinking contest” – The Associated Press