Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review
Introduction Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.Methods This review was conducted using Preferred Reporting Items for Sy...
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2021-12-01
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| author | Martin Howell Anna Rangan Gopala K Rangan Nilofar Dorani Miranda M Zhang Lara Abu-Zarour Ho Ching Lau Alexandra Munt Ashley N Chandra Sayanthooran Saravanabavan Jennifer Q J Zhang Annette TY Wong |
| author_facet | Martin Howell Anna Rangan Gopala K Rangan Nilofar Dorani Miranda M Zhang Lara Abu-Zarour Ho Ching Lau Alexandra Munt Ashley N Chandra Sayanthooran Saravanabavan Jennifer Q J Zhang Annette TY Wong |
| author_sort | Martin Howell |
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| description | Introduction Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.Methods This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946–2019) were included.Results A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.Conclusion Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.PROSPERO registration number A pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809). |
| format | Article |
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| spelling | doaj-art-56d3a463795b4ddd9dc3bcad21aecdbb2025-08-20T02:20:32ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2020-046539Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic reviewMartin Howell0Anna Rangan1Gopala K Rangan2Nilofar Dorani3Miranda M Zhang4Lara Abu-Zarour5Ho Ching Lau6Alexandra Munt7Ashley N Chandra8Sayanthooran Saravanabavan9Jennifer Q J Zhang10Annette TY Wong11Centre for Kidney Research, The Children`s Hospital at Westmead, Westmead, New South Wales, AustraliaNutrition and Dietetics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaMichael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, AustraliaIntroduction Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.Methods This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946–2019) were included.Results A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.Conclusion Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.PROSPERO registration number A pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809).https://bmjopen.bmj.com/content/11/12/e046539.full |
| spellingShingle | Martin Howell Anna Rangan Gopala K Rangan Nilofar Dorani Miranda M Zhang Lara Abu-Zarour Ho Ching Lau Alexandra Munt Ashley N Chandra Sayanthooran Saravanabavan Jennifer Q J Zhang Annette TY Wong Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review BMJ Open |
| title | Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review |
| title_full | Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review |
| title_fullStr | Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review |
| title_full_unstemmed | Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review |
| title_short | Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review |
| title_sort | clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults a systematic review |
| url | https://bmjopen.bmj.com/content/11/12/e046539.full |
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