Can You OD on Water?

by David on February 4, 2013

It may seem like a silly question, since water is probably one of the safest things you can drink, and drowning isn’t technically an overdose. It’s certainly not the sort of frippery that you’d expect to kick off Mind the Science Gap’s winter 2013 season (Welcome back!). After all, it’s water. Well, as any toxicologist worth his (or her!) salt will tell you, it’s the dose that makes the poison, and yes, you can overdose from drinking water. In fact, there’s a fair amount of medical literature out there on the subject because it’s not as uncommon as you might think.

If you gaze into the abyss, the abyss gazes also back at you.

A potential drug den?


The symptoms of water overdose – or, “water intoxication” as doctors and people with fancy coats call it – are similar to alcohol intoxication: headache, nausea, vomiting, confusion, drowsiness, and, in extreme cases, even death. Water overdose is most commonly associated with drug abuse and compulsive disorders, but it can occur whenever someone downs glass after glass of water in rapid succession. By drinking such large volumes of water so quickly, victims push their kidneys (which are nature’s pee-factories) into overdrive, causing them to pee excessively to get rid of it all the extra fluid. This wouldn’t be a problem, except that all that urine is carrying with it a bounty of salt that the body needs to function normally. As the balance of salt-to-water slips out of whack (the salt-to-water ratio in cells is called “osmolarity”), the drinker becomes intoxicated and experiences symptoms. Like alcohol intoxication, water intoxication is reversible, depending on the amount of liquid consumed, provided that the body is gradually given salt and has time to recover.

Battle not with Monsters, lest ye become a monster.

The horror. THE HORROR.

Water intoxication that results from drug abuse is typically caused by the abuse of either opiates or MDMA (also known as “ecstasy”). In the case of opiates, water overdose is caused the same manner I described earlier—opiates make users chronically thirsty, so they drink lots of water, leading to excessive peeing and so forth—but in the case of MDMA, it’s the result of excessive sweating. Since MDMA is often used as a party drug, abusers tend to take a lot of it and go out dancing for many, many hours, and because they know that they’re going to get dehydrated from dancing, they drink a lot of water. Since they’re losing tons of salt through their sweat and they’re not replenishing it because they’re only drinking water, the osmotic balances in their sweaty dancing bodies are ruined, and water intoxication ensues.

Note: I have never actually been to a club.

When I go to da club all I be drinkin’ is Gatorade girrrrrrl

Okay, so it’s possible. Then how much is too much?

Well, it depends. The lethal dose of H2O varies from person to person and depends on a bunch of other factors: how much water you drank, how fast you drank it, what else you were consuming at the time (food, drugs, alcohol, deceptively-convincing pieces of plastic fruit), if you having any health conditions (illness, diabetes, pregnancy, ect.), or if it’s really hot out or if you’re at a high altitude, and oh man there are like a billion things.

This is all to say that, basically, drinking water is fine, and most people could stand to drink a little more water during the day – daytime fatigue is often dehydration in disguise – the key is to not drink a ton of it in one go. Just space that water out, you know? Your kidneys can safely pass a maximum 15 liters of water a day (about seven-and-a-half 2-liter bottles’ worth), but you shouldn’t drink that much anyway. The Mayo Clinic recommends the consumption of at least eight 8-ounce glasses of liquid per day, which should include some water, but can also include things like milk, or tea, or delicious, delicious grape juice.

It was the only free picture of juice I could find. Pretend it's grape. Use your imaginatioooooooooonnnnnn

mmmmmmmmmmmmmmmmmmmm

Of course, if you’re sweating a lot, especially from work or exercise, you should probably drink more water than you normally would, and if you’re really going to town, also maybe a sports drink to replenish the sodium you lose from sweating.

In conclusion, yes, it’s possible to O.D. from drinking water. No, it’s not likely that you, personally, will do it. Yes, you and I should probably both consider drinking more water and less soda pop/coffee/hooch (well maybe the last one’s just me). And naturally, you should subscribe to the RSS feed and enjoy another glorious semester of MTSG! Down in front, now, no shoving! Plenty of science for everyone…

 

Important Citation:

Radojevic, N., Bjelogrlic, B., Aleksic, V., Rancic, N., Samardzic, M., Petkovic, S., & Savic, S. (2012). Forensic aspects of water intoxication: Four case reports and review of relevant literature. Forensic science international.

Tom Holder February 4, 2013 at 6:44 am

A woman died after a water drinking contest in California throught water intoxication
http://www.cbsnews.com/2100-201_162-2358958.html

David February 4, 2013 at 12:56 pm

Yeah, I remember hearing about this back when it happened. It was really unfortunate and I still think it was an astoundingly irresponsible idea for a competition.

Hilary Sutcliffe February 4, 2013 at 6:50 am

I’m training for a marathon and I was surprised that much of the discussion about hydration in relation to marathon running is about drinking too much water, and the harm that can do, rather than drinking too little. Many runners are so worried about the water loss that they drink too much with many of the symptoms you describe in relation to salt loss – so electrolyte fluids etc are recommended too.

However I would also guard against recommending such a huge amount of grape or other fruit juices. In the UK there are warnings against too much of that too – for a few reasons:

* basically it is a huge sugar hit, with all the downsides that entails
* bad for the teeth (stories of kids having to have their baby teeth taken out from decay due to drinking too much juice!)
* and a big waste of calories, which if you are going to be ‘bad’, could, in my view, be better spent on cake (!) but probably better of using for something nutritious. I’m afraid huge amounts of juice ar not much better than huge amounts of any sugary beverage.

Thanks for the post!
Hilary

David February 4, 2013 at 1:00 pm

I’m glad you liked it! I’m pleased to hear that this topic is making the rounds in the training of endurance athletes. And you’re right about avoiding too much juice – everything in moderation!

Janey Burton February 4, 2013 at 7:04 am

Anthony Andrews the actor had a problem with this a few years ago while he was in a theatre production. He described the constant water drinking very much like an alcoholic and made a direct comparison in terms of it being a sort of addiction.

David February 4, 2013 at 1:02 pm

From what I’ve read in the literature, it’s an apt comparison for some people. Thanks for the comment!

Regis Dudley February 4, 2013 at 8:02 am

Good info!

I haven’t heard about this since that horrible “Hold your Pee for a Wii” incident (http://thelede.blogs.nytimes.com/2007/01/15/too-high-a-price-for-a-wii/). Thanks for being responsible and addressing how water intoxication relates to drug use, David.

David February 4, 2013 at 1:06 pm

I’m glad you liked the piece! I came across the connection between water intoxication and drug use while I was researching the topic and thought it was absolutely fascinating.

Ashley Patriarca February 4, 2013 at 8:23 am

Great first post! I especially appreciated the humor – the caption “The horror, the horror” actually made me laugh so hard people on the bus started staring. The captions mostly strike a nice balance between humor and communicating important information, which is a tough thing to do.

At the same time, you presented the information in a fairly informal, yet utterly straightforward and easy to understand way (which is even more important in the long run than the humor). I learned quite a bit that I didn’t already know about water & hydration, so when I inevitably get sleepy around 1:30 I’ll go grab some water instead of caffeine. Thanks!

David February 4, 2013 at 1:07 pm

Haha, that’s wonderful! Your comment makes me feel like I’ve succeeded, thank you!

Ashley Patriarca February 5, 2013 at 4:31 pm

Well, until I send you the bill for the new computer screen I need now :) Seriously, though, I’m consistently impressed with the posts the writers on this blog produce.

Michael Grisafe February 4, 2013 at 9:54 am

Awesome way to start! I’m also reading this on the bus ride in, and your post made me laugh out loud (which is probably the only time I can use “lol”!). Great presentation of info in a smart and funny manner! I look forward to future posts. Ps as a side note, do you read Chuck Klosterman? You’ve got a bit of his voice in your work that I dig.

David February 4, 2013 at 1:10 pm

Thank you! I’m glad you liked it. No, I haven’t read any Chuck Klosterman, but he sounds like someone I should look into. :)

(Additionally, if you enjoyed the humor of the post, I highly, highly recommend John Green, whose novels are my current literary obsession.)

Michael Grisafe February 5, 2013 at 1:18 am

Nice! I’ll have to check Mr. Green out. One more reason not to do my public health reading…

Trisha February 5, 2013 at 7:16 pm

Great post David! Ever since I heard that you could die from drinking too much water, I’ve always wondered about this. I’m so glad that you’re contributing to Mind the Science Gap this semester, and I look forward to your future posts.

P.S. Loved the captions.

David February 6, 2013 at 11:37 am

Thank you, I’m glad you enjoyed the post!

Margaret Freaney February 6, 2013 at 12:48 am

David,
Like many others I really like your style. The humor and accessibility of your writing is very good. I did find your research a little lacking. I know there are way more medical articles on this out there. What was your reason for choosing the ones you did?
Again, really liked your post. Your style is great!
Margaret

David February 6, 2013 at 11:56 am

Margaret,
I’m glad you enjoyed the post, and I think you raise a fair point about the paucity of references – one should always be wary of scientists who only cite one source! In this case, I’m still learning the balance between science writing for scientific papers, wherein nearly every, or every other sentence has a citation, which is good for researchers, but makes blog posts cumbersome, and writing for scientific blog posts, which require only enough citations to support the general scientific concepts I’m trying to communicate.

While researching for this post, I did read through a preponderance of water intoxication case reports and review articles (hooray for PubMed!), but in the interest of economy, thought it prudent to simply cite what I considered to be an extremely effective review of the topic. Essentially, rather than cite the review and all of the case reports that I read – many of which are also cited in the review paper – I simply cited the review to save time and space.

As to the websites I linked to, I felt that the Mayo clinic provided a helpful and accessible guide to proper hydration, and that the other site basically echoed the Mayo site, but also brought up the connection between dehydration and drowsiness, which I wanted to mention.

Your comment is well received – it’s important to think critically about where information comes from! Also, I’m very glad that you think I’m funny :)
David

Margaret Freaney February 6, 2013 at 9:13 pm

David,
I will have to admit that I love looking at the research behind these articles, so I might be a person who leans to scientific paper research. Thanks for the well thought out response. I look forward to next weeks article.
Margaret

Kiya February 7, 2013 at 12:45 am

Thanks for this post David. You blogged on an interesting topic that is relevant to all of us.
I have two comments, both referring to language use:
1) I was intrigued to see that all comments before me have applauded your humorous writing, since for me, it was too much. I think that getting the balance right between entertainment and information is a very tricky, yet central issue to your exercise. When it comes to health information I prefer good writing (which entertains me) and some humour, but not too much. What is too much is different for different people, and it seems you got it right for the majority of people, at least the ones who commented. I guess different topics vary in the amount of jokes that are appropriate; and water seems like a safe topic to be funny about. I think that my sense of credibility of the writer as a reliable source suffers just a little when it the writing is too funny. I recently read a blog regarding the credibility that readers assign to scientific articles with cutesy/funny titles. (Less than to not so funny/cute titles.) Slightly different context but maybe relevant. Unfortunately, I have failed to dig up the post.

2) Not all people who use drugs abuse them. I try to remember that what is an illegal and/or unacceptable substance in one culture/country/era/subgroup may be perfectly fine in another space and time. Referring to people who take drugs as ‘users’ seems less judgmental to me. If we want to get messages across to at-risk groups (drug users would be such a group in the case of water OD), language is important. I imagine that when we feel judged we are less likely to follow good advice than when we feel cared for/considered.

Thanks for being part of this great exercise. I do look forward to every new post I see.

David February 8, 2013 at 11:49 am

Kiya,
Thanks for the comment! I appreciate your perspective and candor. To address these ideas more directly:
1. I certainly agonized over the level of humor that was appropriate to the post, and I’m kind of surprised that I didn’t get a comment about it sooner. For a few reasons, I decided to err on the side of more jocularity, rather than less: it was the kick-off post for MTSG and I wanted to start things off on an amusing note; in my experience, people remember information better if it’s tied to something that evoked an emotional response (in this case, jollity); and, as you said, water is a fairly safe topic to be funny about. Additionally, I too am wary of informative articles that shoehorn in silly titles or unnecessary humor for the sole purpose of engaging the audience (having worked in publishing, I have to say, I don’t understand the journalistic obsession with puns, but it is certainly a uniform trait among them). Further, since the answer to the titular question “can you OD on water?” is a fairly straightforward “yes, it’s possible,” I felt that I had a bit more leeway to have fun with the explanation as to how this overdose might be achieved and the physiological processes underlying it.

2. I wholeheartedly agree that it is extraordinarily prudent to be sensitive to cultural biases in the definitions of both “drugs” and “abuse,” and I certainly attempted to avert the problem with specific language – alas, I see I have failed. My intention behind using “abusers” rather than “users” was to distinguish between those who use drugs, and those who abuse them. Certainly, not all who use drugs abuse them, and there are plenty of drugs referred to in popular media as “drugs of abuse” when they have plenty of potential as therapeutic agents. With regards to MDMA, there is an abundance of literature (DOIs: 10.1007/s00213-007-0703-5, 10.1177/0269881109102787, 10.1177/0269881112464827, 10.1177/0269881107069029) that suggest the potential for therapeutic use of the drug, so the use/abuse paradigm must be adjusted for those taking it as part of a clinical trial. It is worth noting, however, that water intoxication is unlikely to occur during such trials, since patients are monitored by physicians to prevent such outcomes. It’s tricky to write for a global audience with so much cultural and legal variation in the definitions of drugs and the abuse thereof, and certainly something that I will need to balance when writing future posts. Thank you for your comment!
Cheers,
David

Justin Ward February 28, 2013 at 9:34 am

That was a great article! It was very interesting! I liked how you connected overdosing on water and Alchol intoxication, and how you included information about what it actually does to the body and how it occurs.

I did not know that you can get the same symptoms of Alchol intoxication just from drinking water! I also did not know that your kidneys can pass 15 liters of water in 1 day and that time effects how the water you drink,it is really like Alchol the more you drink in one go the more it effects you.

One of my science teachers in middle school, told me a story about a student that goes to a local university, died from having a water drinking contest.

I’m now curious if it is possible to overdose on other substances that no one would think is possible.Like milk is it possible to overdose on milk? And what is the connection of drinking to much water and not drinking enough water?

#SPX9

David March 24, 2013 at 3:26 pm

Ah, I apologize for the delayed response! The e-mail comment alert seems to have slipped past me.

Anyway, interesting questions, Justin! As far as milk goes, I would expect (from my experiences observing milk-drinking competitions [yes, this is a thing I have seen]) that the body would be apt to induce vomiting in most other cases of intoxication, such as milk intoxication. Water is extremely inert, in addition to being vital to our survival, so it’s easier to drink a lot of it – especially when you’re sweating a lot.

As to your second question: Most people would probably be better off drinking more water and fewer sugary drinks, and water overdose is generally only an issue for endurance athletes and individuals who consume it compulsively (e.g. drug abusers, or those with compulsive disorders). I would imagine that there are likely significantly more people drinking too little water than there are people drinking too much water.

Thanks for the questions!

Emily February 28, 2013 at 9:47 am

Hello,
I really enjoyed this article about how you can overdose on water. I liked how you discussed the symptoms of drinking too much water and how they are similar to the symptoms of alcohol intoxication. Furthermore, I thought your pictures were helpful along with their funny caption. It surprised me that you can actually drink too much water because now a day we’re encouraged to drink as much water as we can to stay hydrated all the time. It also surprised me that you do not overdose on water just because you’re drinking too much, but because it throws off the salt-water ratio in your body. Now I know that you lose the salt your body needs to function because you’re going to the bathroom so much. I was interested in this article because as a dancer we’re told to drink water at the begining of class because we aren’t allowed to while the teaching is teaaching. Therefore I always drink a big bottle quickly before my class to stay hydrated. Now I know that as important as it is to drink water, I shouldn’t over do it or I could receive some serious consequences. I do have some questions though. Why do the water bottle companies not warn the consumers that drinking too much water can cause serious even fatal consequences? If someone ended up in the hospital because of an overdose of water from a specific company couldn’t they file a law suit against that company? Also, how could you stop yourself from drinking too much water? All in all, great article! #SPX9

David March 24, 2013 at 3:41 pm

So sorry for the late response! All the same, I’m glad you liked the article, and I think you raise good questions, Emily!

I imagine that bottled water companies don’t include warnings on their products because water intoxication is far less of a public concern than, say, irresponsible alcohol use. While it is indeed possible to overdose on bottled water, it’s not particularly likely to occur during routine daily use of the product. And while a person could theoretically sue the bottled water companies for an overdose, the companies might ask why the person doesn’t sue their municipal water supplier as well – after all, you can overdose from tap water just as easily as bottled water. there’s nothing special about bottled water that makes it more or less dangerous if you drink too much of it under the wrong circumstances.

Again, I do want to emphasize that it’s very important to drink plenty of water! Proper hydration is an important aspect of any kind of physical activity, and should be considered just as important as any other aspect of training. That said, a knowledge of one’s own body is very important for knowing when, and how much water or sport’s drink to consume. The Mayo Clinic (http://www.mayoclinic.com/health/water/NU00283) provides a pretty good primer for helping you figure out how much water you need, but a good general rule is to drink fluids when you’re thirsty, and not just for the sake of drinking fluids.

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