Review articleForensic aspects of water intoxication: Four case reports and review of relevant literature
Introduction
Changes in osmotic gradient in blood, extracellular and cellular compartment due to increased loss, increased intake or retention of water in the body, followed by saline imbalance, causes the maldistribution of water among these compartments and general disorder in water metabolism. Hormone regulation of water metabolism includes vasopressin (ADH, antidiuretic hormone which increases the reabsorption of water from the renal tubules), aldosterone (which reabsorbs sodium and excretes potassium in the kidneys) and a group of natriuretic hormones (which excrete sodium and water).
Water intoxication (WI), hyperhydration or water poisoning, is a rare condition that originates from overconsumption of water, with a potentially fatal outcome. This primarily affects the brain function. Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI.
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Methods
We evaluate two unusual pediatric clinical cases of WI (polydipsia & polyuria) using medical documentation and police case files, and two fatal adult cases subjected to autopsy.
Case 1
A 5-year-old boy (112 cm, 22.5 kg) was admitted to a pediatric hospital due to strong thirst, excessive water intake (ca. 6 L a day) and frequent urination. The problems lasted for 10 days. He was the eldest child of the family, and was born 15 days premature. He had suffered from frequent bouts of bronchitis and atopic dermatitis, and two years previously he had infective mononucleosis. His mother had contact dermatitis to some metals and his grandfather had suffered from diabetes mellitus type II.
Discussion
Excessive water intake is compensated for by higher diuresis, but the kidneys of a healthy adult can process a maximum of 15 L a day, while the osmolarity of urine falls below 300–400 mosm/L. When the kidneys’ compensatory ability for water processing passes the limits, WI or hypotonic hyperhydration appears. It leads to the forming of concentration gradient between extracellular and intracellular compartments, especially in brain tissue and consequent brain swelling (edema). Brain damage occurs
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2021, Psychiatry ResearchCitation Excerpt :The item scores obtained in the second round were used to weight the items in the severity scale. A total of 27 studies met the eligibility criteria (Fig. 2) (Abbasi et al., 1997; Atsariyasing and Goldman, 2014; Boyd, 1990; Bremner and Regan, 1991; Bugle and Andrew, 1992; Colls et al., 2000; Cosgray and Boyd, 1992; Delva and Crammer, 1988; Goldman, 2010; González et al., 2008; Hayfron-Benjamin et al., 1996; Kawai et al., 1999; Lawson and Karson, 1985; Millson et al., 1992; Perestrelo and Teixeira, 2016; Radojevic et al., 2012; Reynolds et al., 2004; Ribble and Thelander, 1994; Sailer et al., 2017; Shutty et al., 1995, 1992; Snider and Boyd, 1991; Stiefel and Petzold, 2007; Tracy et al., 1997; Vieweg et al., 1988, 1986b; Vieweg et al., 1985). All items concerning clinical variables and behaviors included in these studies are shown in Table 1 and Supplemental eTable 1, respectively.
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2014, Legal Medicine
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Institute of Forensic Medicine, “Milovan Milovanovic”, School of Medicine, University of Belgrade, Deligradska 31a, 11000 Belgrade, Serbia. Tel.: +381 63 8989 155.
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School of Medicine, University of Belgrade, Deligradska 31a, 11000 Belgrade, Serbia. Tel.: +381 11 2682 522.
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Present address: Susedgradska 41a/5, 11090 Belgrade, Serbia. Tel.: +381 63 8524 443.
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Department for Endocrinology and Diabetes, Institute of Sick Children, Medical Faculty, University of Montenegro, Ljubljanska 1, 20000 Podgorica, Montenegro. Tel.: +382 67 548 861.
- 5
Department of Forensic Medicine, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1-7, 21000 Novi Sad, Serbia. Tel.: +381 21 454 927.
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Institute of Forensic Medicine, “Milovan Milovanovic”, School of Medicine, University of Belgrade, Deligradska 31a, 11000 Belgrade, Serbia. Tel.: +381 11 2682 522.