When you think about “consuming an excessive amount of alcohol,” chances are you’re not thinking about overdoing it on water. We hear so much about drinking sufficient water these days that it might seem like there’s no such thing as overhydrating. It’s true, of course, that hydration is a top priority for well-being, but there’s a lesser-known flip side to this health advice. Consuming an excessive amount of water in too short a time can actually be dangerous—or even lethal.
Recently, multiple news stories have emerged about individuals who have died from so-called “water intoxication.” High temperatures and grueling fitness challenges appear to have fueled individuals to consume more fluids than their kidneys can handle, causing sodium levels to decrease to a point so low as to result in death.
While experiencing health problems or dying from overhydration is, admittedly, rare, it’s important to realize that, when it comes to water, more isn’t always better. Here’s what to know about getting enough, not guzzling too much.
What is Overhydration?
To maintain proper fluid levels, your body is constantly balancing a delicate equilibrium of electrolytes. For a quick refresher: electrolytes are electrically charged elements that keep fluid at the proper levels inside your cells. These include sodium, potassium, magnesium, chloride, and others. You probably know you can lose electrolytes through sweat—hence the common recommendation to drink beverages that replenish electrolytes after long exercise sessions.
The issue is, if you lose an excessive amount of electrolytes and attempt to rehydrate with abundant amounts of water (which doesn’t contain electrolytes), you run the risk of diluting your blood to a dangerous point. This can ultimately create a condition called hyponatremia.
From the Latin “hypo” (meaning “insufficient”) and “natrium” (meaning “sodium”), hyponatremia is defined as a serum sodium concentration of 135 mEq/L. (Normal blood sodium levels are typically from 136-145 mEq/L.) With too much water and an inadequate amount of sodium in the blood, your body can’t perform essential functions. And when you don’t have enough sodium to regulate fluid levels, excess water can enter the brain cells, causing life-threatening brain swelling.
Causes and Risk Factors
Again, overhydration is considered rare—you’re significantly more likely to become dehydrated than overhydrated—but understanding its causes and risk factors can help you avoid it.
, having a health condition that causes fluid retention puts you at a greater risk of excessive hydration, since your kidneys may not be able to effectively eliminate water. Medical conditions such as kidney disease, congestive heart failure, liver disease, and uncontrolled diabetes can all increase the likelihood of water intoxication. Certain medications have the same effect. Antihypertensives, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs) are all known to cause fluid retention. Consuming excessive amounts of water while taking these medications or living with these conditions could lead to dangerously low levels of electrolytes.
However, water intoxication often arises not from a health condition, but rather from your level of physical activity. It frequently occurs after engaging in high-intensity athletic events. “Individuals who consume excessive amounts of water while participating in marathons, ultramarathons, triathlons, and other long-distance, high-intensity activities are at an increased risk of hyponatremia,” says dietitian and personal trainer Wan Na Chun, MPH, RD, CPT.
This makes sense, of course. After intense and sweaty exercise, we have an urge to replenish our body’s fluid reserves. However, losing electrolytes through sweat and consuming copious amounts of water can be a hazardous combination. “Engaging in prolonged exercise while also consuming excessive amounts of water can put you at risk for hyponatremia because you lose sodium through sweat,” states Jamie Nadeau, RD. “If you exercise for longer than an hour, it’s advisable for most individuals to include a beverage with electrolytes, such as sodium.”
Indications and Symptoms
The indications of excessive hydration can begin subtly. After drinking a considerable amount of water (particularly with a health condition or following an endurance event like a marathon), you may experience nausea, headache, disorientation, vomiting, muscle cramps, or edema. Initially, distinguishing these symptoms from overexertion can be challenging.
However, if left untreated, water intoxication can progress to more severe neurological effects. When brain cells swell due to excessive water, it can lead to a coma and even death.
If you suspect that you may be consuming an excessive amount, pay attention to physical signals such as the frequency of urination and the color of your urine. Urinating more than once every few hours or having completely clear urine could indicate overhydration.
Diagnosis and Treatment
Physical indications and symptoms are helpful for identifying water intoxication, but the most reliable diagnostic tool is a blood test. This test can determine whether your sodium levels have fallen into the dangerous range of hyponatremia. Some doctors may also employ a urine test to diagnose the condition.
If it is determined that you have water intoxication, the appropriate treatment options may vary. “The typical approach to treating overhydration/hyponatremia depends on the severity of the condition,” explains Chun. “Mild cases can be managed by reducing fluid intake, while more severe cases may necessitate intravenous fluids or medications to restore electrolyte balance.
Prevention and Healthy Hydration
We all desire to achieve that perfect balance of just enough and not excessive water. For optimal well-being, begin by heeding your body’s signals. Drinking in response to your level of thirst is typically a dependable method of properly hydrating.
When uncertain, you can also adhere to public health recommendations for hydration. “Generally, men require about 15.5 cups of water per day and women require about 11.5 cups of water per day, so if you’re consuming more than that, it’s worth examining why,” says Nadeau.
Additionally, bear in mind that guzzling an entire day’s worth of water in one sitting is not the objective. “It’s crucial to ensure that you’re distributing that water throughout the day consistently and not simply consuming it all within a narrow timeframe,” Nadeau points out. “The CDC suggests a maximum of 48 ounces of water per hour.”
And do not overlook the fact that water is not the sole means of hydration. Balancing your H2O intake with moisturizing foods such as soups, popsicles, and fruit increases your daily fluid accumulation while often enhancing electrolyte levels. Electrolyte drinks certainly have their time and place as well. Whether it’s a sports beverage, juice, or even a glass of milk, drinks rich in electrolytes ensure that you stay properly hydrated without risking perilous imbalances.
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