Dilutional Hyponatremia & Mental Illness

Water intoxication is a potentially life-threatening condition resulting from low levels of sodium and excess fluids that can enter and swell the body’s cells.

Water in the human body is comprised of electrolytes and ions, which helps cells to function. The human body is usually adept at keeping fluids and electrolytes in a balanced state, but can become imbalanced under certain conditions. Dilutional hyponatremia, or water intoxication, occurs when an individual drinks an excessive amount of water without consuming enough electrolytes. This triggers an imbalance, as water enters the body’s cells and causes them to swell. Dilutional hyponatremia is a serious condition and could potentially be life-threatening.

Individuals with various mental health conditions such as schizophrenia, schizoaffective disorder and bipolar disorder are at higher risk for hyponatremia. Studies have shown that 3-25% of inpatient psychiatric populations are diagnosed with primary polydipsia, or compulsive water drinking. People who engage in compulsive behaviors or who are struggling with various addictions are also at a higher risk.

Conditions Causing Dilutional Hyponatremia

Dilutional hyponatremia occurs when sodium levels fall in the blood, disrupting the regulation and balance of body fluids. Dilutional hyponatremia can result from medical conditions, certain medications or from drinking exorbitant amounts of water.

Medical conditions and diseases that impact the heart, kidney or liver can result in the accumulation of body fluids, which can dilute and lower sodium levels. Serious and chronic diarrhea and vomiting represents another condition that can result in dehydration, causing the body to lose electrolytes. Diabetes and high blood sugar can cause frequent urination, which can cause dehydration and increased thirst.

Medications that disrupt hormonal and kidney functioning can result in dilutional hyponatremia, as these processes regulate sodium levels. Water pills, pain medications and antidepressants are a few medications that can disrupt the regulation of sodium in the body.

Drinking excessive amounts of water can interfere with the kidney’s ability to remove water. When the kidneys become overwhelmed from excess water intake, low sodium can result.

Dilutional hyponatremia occurs in disorders that are associated with substance use and mental health issues. Individuals that abuse Ecstasy or stimulant drugs can elevate the risk of developing hyponatremia. People who use alcohol and drugs may drink a lot of water in an effort to remove the drug from their bodies. Individuals with an eating disorder may attempt to drink inordinate amounts of water to lose weight, or may exercise excessively while rehydrating only with water.

Substance Use Disorder

Dilutional hyponatremia is frequently reported in individuals with chronic substance use disorders. Individuals may develop the condition from abusing stimulants, from drinking beer or from attempting to rapidly detoxify their body of drugs or alcohol.

• Stimulant-induced overhydration: Individuals who take ecstasy can become very thirsty as a result of exertion, body temperature and dehydration. People who take ecstasy overexert themselves and sweat easily, prompting them to drink water for relief. Ecstasy is an antidiuretic, which makes a person retain water, elevating the risk of water intoxication. Stimulant abuse can result in thirst cravings and poor judgment may result in a person drinking excessive amounts of water to fast.
• Drinking beer: Individuals who consume excessive amounts of beer can be at risk of water intoxication. Beer contains a minimal amount of sodium and when combined with unhealthy nutrition, can lead to accelerated sodium loss.
• Rapid drug detoxification: People may attempt to drink an excessive amount of water in order to rid their body of drugs and alcohol. Individuals that abuse substances may try to overhydrate so that they can rapidly flush the substances out of their system.

Psychogenic Polydipsia

Psychogenic polydipsia is also known as compulsive water drinking and results from excessive thirst. The compulsion to seek and drink fluids excessively is frequently displayed in individuals with mental illness. Self-induced water intoxication can result in hyponatremia. Psychogenic polydipsia hyponatremia is commonly seen in individuals with chronic schizophrenia. Of those diagnosed with psychogenic polydipsia, 80% also have a diagnosis of schizophrenia.

Other mental health conditions linked with psychogenic polydipsia include schizophrenia, affective disorders, personality disorders, and childhood-onset psychosis and more.

• Personality disorders: People with personality disorders, such as histrionic personality disorder, possess an unmanageable urge to drink water even though it is not necessary or indicated.
• Mood disorders: Psychogenic polydipsia is linked with psychiatric mood disorders, including depression and bipolar disorder. Early indications of sodium deficiency can mimic psychosis or bipolar disorder, as it can intensify symptoms of psychosis.
• Eating disorders: People diagnosed with eating disorders may attempt to lose weight by drinking excessive amounts of water.
• Body dysmorphia & obsessive exercise: Individuals who have body dysmorphia and who engage in obsessive exercising can sweat, become dehydrated and drink an excessive amount of water without electrolytes.

Dilutional Hyponatremia Symptoms

Dilutional hyponatremia symptoms occur as water moves into brain cells, causing them to fill and swell. Dilutional hyponatremia is a potentially life-threatening condition. The severity and duration of symptoms can warrant emergency intervention. Individuals who show severe water intoxication symptoms should seek emergency medical care right away.

Signs of water intoxication can include:

• Headaches
• Decreased energy and fatigue
• Seizures
• Irritability
• Increased mental confusion
• Impaired reflexes
• Slurred speech
• Nausea and vomiting
• Muscle spasms or cramps

Dangers of Dilutional Hyponatremia

Dilutional hyponatremia is often misdiagnosed or goes unrecognized during early stages. Early detection and accurate diagnosis are paramount to prevent severe dilutional hyponatremia, which can result in seizures, brain edema, swelling, coma or death.

Water intoxication deaths occur most often when exorbitant amounts of water are ingested in a short duration of time, but can also occur when water is consumed over a longer period of time. The most frequent deaths from dilutional hyponatremia occur in the psychogenic polydipsia population, comprised of individuals who drink compulsively and who commonly have mental health conditions.

Prevention Of Dilutional Hyponatremia

How to prevent water intoxication is by being mindful and reducing fluid intake. People with medical conditions, such as diabetes or kidney disease should be closely monitored by a physician, especially if excessive thirst develops. While exercising, individuals should consume sports beverages in addition to water and should not drink excessive amounts of water in a short time period.

Treatment Of Dilutional Hyponatremia

The treatment of dilutional hyponatremia is based on the severity of symptoms along with their origin. Water intoxication treatment is usually determined by the underlying condition that prompted it. How long water intoxication lasts depends on the level of severity of the condition. Water intoxication should be treated within hours to avoid complications that can result from leaving it untreated for more than one to two days.

Treatment interventions can include reducing fluid intake, consuming diuretics to elevate urine output, or terminating usage of medications that may be causing the problem. In severe cases, emergency medical care is necessary to regulate sodium levels in a safe manner. A physician may prescribe medication to help a person to manage symptoms of water intoxication.

Editor – Rob Alston

Rob Alston has traveled around Australia, Japan, Europe, and America as a writer and editor for industries including personal wellness and recovery. Read more

Medically Reviewed By – Tracy Smith, LPC, NCC, ACS

Tracy Smith is a Licensed Professional Counselor, a Nationally Certified Counselor, an Approved Clinical Supervisor, and a mental health freelance and ghostwriter. Read more