Strange but True: Drinking Too Much Water Can Kill

https://www.scientificamerican.com/article/strange-but-true-drinking-too-much-water-can-kill/

In a hydration-obsessed culture, people can and do drink themselves to death.

By Coco Ballantyne on June 21, 2007  44

Liquid H2O is the sine qua non of life. Making up about 66 percent of the human body, water runs through the blood, inhabits the cells, and lurks in the spaces between. At every moment water escapes the body through sweat, urination, defecation or exhaled breath, among other routes. Replacing these lost stores is essential but rehydration can be overdone. There is such a thing as a fatal water overdose.

Earlier this year, a 28-year-old California woman died after competing in a radio station's on-air water-drinking contest. After downing some six liters of water in three hours in the "Hold Your Wee for a Wii" (Nintendo game console) contest, Jennifer Strange vomited, went home with a splitting headache, and died from so-called water intoxication.

There are many other tragic examples of death by water. In 2005 a fraternity hazing at California State University, Chico, left a 21-year-old man dead after he was forced to drink excessive amounts of water between rounds of push-ups in a cold basement. Club-goers taking MDMA ("ecstasy") have died after consuming copious amounts of water trying to rehydrate following long nights of dancing and sweating. Going overboard in attempts to rehydrate is also common among endurance athletes. A 2005 study in the New England Journal of Medicine found that close to one sixth of marathon runners develop some degree of hyponatremia, or dilution of the blood caused by drinking too much water.

Hyponatremia, a word cobbled together from Latin and Greek roots, translates as "insufficient salt in the blood." Quantitatively speaking, it means having a blood sodium concentration below 135 millimoles per liter, or approximately 0.4 ounces per gallon, the normal concentration lying somewhere between 135 and 145 millimoles per liter. Severe cases of hyponatremia can lead to water intoxication, an illness whose symptoms include headache, fatigue, nausea, vomiting, frequent urination and mental disorientation.

In humans the kidneys control the amount of water, salts and other solutes leaving the body by sieving blood through their millions of twisted tubules. When a person drinks too much water in a short period of time, the kidneys cannot flush it out fast enough and the blood becomes waterlogged. Drawn to regions where the concentration of salt and other dissolved substances is higher, excess water leaves the blood and ultimately enters the cells, which swell like balloons to accommodate it.

Most cells have room to stretch because they are embedded in flexible tissues such as fat and muscle, but this is not the case for neurons. Brain cells are tightly packaged inside a rigid boney cage, the skull, and they have to share this space with blood and cerebrospinal fluid, explains Wolfgang Liedtke, a clinical neuroscientist at Duke University Medical Center. "Inside the skull there is almost zero room to expand and swell," he says.

Thus, brain edema, or swelling, can be disastrous. "Rapid and severe hyponatremia causes entry of water into brain cells leading to brain swelling, which manifests as seizures, coma, respiratory arrest, brain stem herniation and death," explains M. Amin Arnaout, chief of nephrology at Massachusetts General Hospital and Harvard Medical School.

Where did people get the idea that guzzling enormous quantities of water is healthful? A few years ago Heinz Valtin, a kidney specialist from Dartmouth Medical School, decided to determine if the common advice to drink eight, eight-ounce glasses of water per day could hold up to scientific scrutiny. After scouring the peer-reviewed literature, Valtin concluded that no scientific studies support the "eight x eight" dictum (for healthy adults living in temperate climates and doing mild exercise). In fact, drinking this much or more "could be harmful, both in precipitating potentially dangerous hyponatremia and exposure to pollutants, and also in making many people feel guilty for not drinking enough," he wrote in his 2002 review for the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology. And since he published his findings, Valtin says, "not a single scientific report published in a peer-reviewed publication has proven the contrary."

Most cases of water poisoning do not result from simply drinking too much water, says Joseph Verbalis, chairman of medicine at Georgetown University Medical Center. It is usually a combination of excessive fluid intake and increased secretion of vasopression (also called antidiuretic hormone), he explains. Produced by the hypothalamus and secreted into the bloodstream by the posterior pituitary gland, vasopressin instructs the kidneys to conserve water. Its secretion increases in periods of physical stress—during a marathon, for example—and may cause the body to conserve water even if a person is drinking excessive quantities.

Every hour, a healthy kidney at rest can excrete 800 to 1,000 milliliters, or 0.21 to 0.26 gallon, of water and therefore a person can drink water at a rate of 800 to 1,000 milliliters per hour without experiencing a net gain in water, Verbalis explains. If that same person is running a marathon, however, the stress of the situation will increase vasopressin levels, reducing the kidney's excretion capacity to as low as 100 milliliters per hour. Drinking 800 to 1,000 milliliters of water per hour under these conditions can potentially lead a net gain in water, even with considerable sweating, he says.

While exercising, "you should balance what you're drinking with what you're sweating," and that includes sports drinks, which can also cause hyponatremia when consumed in excess, Verbalis advises. "If you're sweating 500 milliliters per hour, that is what you should be drinking."

But measuring sweat output is not easy. How can a marathon runner, or any person, determine how much water to consume? As long as you are healthy and equipped with a thirst barometer unimpaired by old age or mind-altering drugs, follow Verbalis's advice, "drink to your thirst. It's the best indicator."

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ABOUT THE AUTHOR(S)

Coco Ballantyne

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1. sangamkrApril 13, 2015

When I was seeing a local TV show , I was surprised to note that water is poisonous when consumed excess. To confirm the fact I was goggling and came across this article. The content of this article is interesting and informative. But what if you are hypertensive and consume more water because of the disease? what happens if you have lots of dehydration problem? Have you to drink or not?

Excess water intake become toxic only when kidney's reject pumping the excess water out of the body. Is it true. Would like to have more insight into this strange but true article.

2. redblanket in reply to aprilmarkgrafFebruary 11, 2015

I can say from experience, that this article is 100% true. I was doing a 500 mile triathlon and almost died from drinking water & sports drink in excess. I had all the symptoms above. I tried to eat during the race, but was so nauseated that it was very difficult. Finally on the last day, I was able to get down a tuna sandwich. It saved my life. I can laugh about it now...but at the time I was really scared and thought I was going to die or have brain damage.

3. aprilmarkgrafJanuary 14, 2015

go Wonderwoman1967: the bottles are polluting the entire Earth and the water out of your tap is just fine!

4. yangsir in reply to SingeriNovember 7, 2014

What's the deal now?Healthy or something wrong?

5. rohit127November 4, 2014

Not only after but also immediately after the meal we should not have excess water . after 15-20 mins of meal you may have water.

6. rohit127November 4, 2014

Does excess may cause bleeding from anus ?

7. tanarg in reply to Wonderwoman1967October 21, 2014

Wonderwoman1967: The 8-glasses-a-day of water has been a recommendation since the 1950s! It is not at all a new thing. I know, because I was there!

8. messi56September 16, 2014

I never known that too much drink can kill u,alarm...

9. SingeriAugust 7, 2014

Well, this is my situation. I am 35 yrs old I was on a strict diet for 6 months to shed off my baby weight. My day started with drinking 4 glasses of water, 1 hour of vigorous exercise, water and followed by a green juice. I had sprouts and fruit for breakfast and after 2 hours, I drank another 4 glasses of water. I used to eat heavy lunch and after 2 hours gap, had another 4 glasses of water. Had Snack, followed by 4 glasses and a healthy dinner followed by 4 glasses. I almost drank 20 glasses in a day. I got rid of my constipation and was very happy with my health. I lost 15 kilos weight and was very proud if myself. But, after 6 months, I noticed I was urinating very frequently and was also diagnosed with severe Acid Reflux(GERD). I couldn't exercise any more, my body became very weak and all my other tests results (iron & diabetes) are normal. It's been 1 year now and I am taking Nexium for acid reflux, but my body is still the same (no energy). The doctors are unable to find out the reason and I feel I lost my health. I have to eat only small meals and can't afford to skip a single meal. I feel like fainting and my blood sugars go low if I skip a meal. Do you think excess water has affected my health? I am happy to know what is the real reason as no doctor is helping me out. Thanks.

10. charlesxJune 21, 2014

This article suffers from jumping between metric and Imperial units, and from a lack of details. It says that it could be harmful to drink 8 cups of water per day (approximately 2 liters) but then goes on to say that the kidneys can process 800 to 1,000 milliliters (approximately 3-4 cups) per hour, or one-tenth of that, 3-4 cups per 10 hours, if marathon running. So it's important for the article to say under what circumstances it is harmful to drink 8 cups of water per day, and it doesn't give that point.

11. AnnWirtek in reply to HimaniJune 7, 2014

Last year I had a brain surgery and the biopsy named the tumor as anaplastic oligodendroglioma grade 3. Afterwords for 2.5 months I had a combination of chemo and radiation treatments, then one month break for Christmas and for last 6 months I'm taking chemo. I'm constantly thirsty and I was told to drink lots of water to flush the poison from my system. How should I interpret your article?

I think on average I drink about 4 litters of water purified by Reverse Osmosis a day, plus 2 - 3 mugs of weak black tea with lemon slices.

I can't stand anything sweet, so no juice for me. Is this too much?

I also noticed that I'm perspiring excessively, like nothing before.

Is this something to be worry about?

My local oncologist is not really helpful. He is really a regular GP and health unit made him act as an oncologist since we don't have one in our town.

I would appreciate any comments.

Ann

12. kebil in reply to sctrbrnMay 22, 2014

Your kidneys may be able to excrete an extreme amount of water every day, but it is not just excrete water, it is also excreting sodium and potassium as well as water. It is the dilution of the blood sodium, and by extension, the bodies sodium, that causes the edema and problems. Drinking lots of water balanced with sodium and potassium will do far less damage. That being said, even this in not totally safe and can still result in tragedy.

I remember when I was working in a particular hospital, and a patient came in with a sodium of 90 mmol/l (don't ask me to convert to imperial). He was extremely hyponatremic (low sodium), and fading in and out of consciousness. He had not been drinking water, but an extreme amount of beer for several days. We wanted to pump a crap load of sodium into him ASAP, but this is also dangerous as it can lead to all the myelin surrounding the nerves suddenly shrinking, falling apart, and causing something like an instantaneous lose of proper nerve conductivity through the most important nerve pathways.

Drinking too much water (or any fluid very low in salt) can result in catastrophe. The man I was talking about survived a slow, extremely careful increase in the amount of sodium in his body, while we carefully monitored his heart (because that can also stop, as can all nerve impulses when sodium falls to low), and allowed his body to slowly get rid of the excess water. This just goes to show that it is the dose that makes the poison, and that anything in excess can be tragic.

One last thing, even if you drink something with the correct amount of salt in it, you can still end up diluting your blood to the point that their is not a high enough concentration of hemoglobin (via your red blood cells) to properly deliver oxygen to your brain (and the rest of you). While the rapid excretion of water makes this harder to do, it is still possible.

13. kebilMay 22, 2014

Your kidneys may be able to excrete an extreme amount of water every day, but it is not just excrete water, it is also excreting sodium and potassium as well as water. It is the dilution of the blood sodium, and by extension, the bodies sodium, that causes the edema and problems. Drinking lots of water balanced with sodium and potassium will do far less damage. That being said, even this in not totally safe and can still result in tragedy.

I remember when I was working in a particular hospital, and a patient came in with a sodium of 90 mmol/l (don't ask me to convert to imperial). He was extremely hyponatremic (low sodium), and fading in and out of consciousness. He had not been drinking water, but an extreme amount of beer for several days. We wanted to pump a crap load of sodium into him ASAP, but this is also dangerous as it can lead to all the myelin surrounding the nerves suddenly shrinking, falling apart, and causing something like an instantaneous lose of proper nerve conductivity through the most important nerve pathways.

Drinking too much water (or any fluid very low in salt) can result in catastrophe. The man I was talking about survived a slow, extremely careful increase in the amount of sodium in his body, while we carefully monitored his heart (because that can also stop, as can all nerve impulses when sodium falls to low), and allowed his body to slowly get rid of the excess water. This just goes to show that it is the dose that makes the poison, and that anything in excess can be tragic.

One last thing, even if you drink something with the correct amount of salt in it, you can still end up diluting your blood to the point that their is not a high enough concentration of hemoglobin (via your red blood cells) to properly deliver oxygen to your brain (and the rest of you). While the rapid excretion of water makes this harder to do, it is still possible.

14. HimaniApril 28, 2014

Its very rightly said in the end that "drink acording to your thirst". Its really very difficult to first measure your sweating levels and then count your drinking glasses.

15. tabissoFebruary 11, 2014

Has more to do with the quality of the watter, than the physiological responses it self. This and other articles are forgetting the concentration of very important ions (mineral) for our body. If the water have a Isotonic tonicity and the right amount of the ions (mineral) then you can drink how much you want!

Look for: http://articles.mercola.com/sites/articles/archive/2011/11/27/coconut-water-ultimate-rehydrator.aspx

I've never heard of someone who died by drinking plenty of coconut water!

16. reichenbella in reply to Wonderwoman1967August 10, 2013

You have some very good points! Some of us have to drink water more often than we would normally (just when we're thirsty). For example, constipation calls for drinking more water. I have seen it to help a lot. But the only way you could be harmed from drinking too much water is if you had a mental disorder that made you drink it all the time or something. And anyway, that would only make you dizzy or have a stomach ache in most cases. So I agree with you. I'm drinking less than a gallon a day, so I should be safe, I figure.

17. reichenbella in reply to Egyptian ThunderAugust 10, 2013

Calculate how much you are drinking. If it's less than 5 or so liters (21 cups) a day - which I am pretty sure it is... - then you're fine. Just don't drink it too quickly.

18. cslagenhopJune 27, 2013

You have developed type I diabetes. You need to get in to see your physician or go to the emergency department.

19. MommaKnowsApril 5, 2013

As water is necessary for every cellular action within our bodies and so many medical warnings tell us the population as whole is dehydrated, doesn't it make sense to at least replace what we lose?

20. spbarbatMarch 17, 2013

I think you are missing the point to this article. Many people are aware of dehydration and the effects and will act accordingly if they have the resources because it is pretty much common sense you need water to live. I believe the amount of people that know you can die from drinking a large amount of water is low. Also, people that are going through extreme dehydration are not thinking, " I really need water but what if I drink too much and die" it is because is isn't available to them or they are ignoring their body. I think it is a good article and is very interesting and informative.

21. Anchovy_RancherJuly 19, 2012

I used to live just outside of the National Park boundaries on the South Rim of The Grand Canyon. I hiked allot during all seasons. I never drank less than one gallon of water per day, ever, while hiking. The question of "what is too much water?" is largely dependent upon "where" it is that we're talking about. Go hike the canyon and get back to me about how much water you went through. I never carried less than two gallons while hiking off of the main trails. It's 20 pounds of life sustaining stuff!

p.s.: There are "seeps" and small creeks to filter and drink but you have to be both lucky and know where they are.

22. mnmndbMarch 12, 2012

I know this is an old article but I still hope someone can give me an answer. My husband drinks a to of water and gets upset when I tell him that it is too much. Just to make him realize how much it truly is I counted all the water bottles (we refil plastic water bottles with filtered tap water until they cant be used any more, so please no negative comments on that)he drinks in a day every day. We came to a total of between 22 - 25 bottles (0.7 ml each.)Thats a total of about 15 liters ( close to 4 gallons)a day on a normal day in the 60's and no exercise.And he still feels thirsty all the time. If I tell him its too much he tells me if he drinks less he starts feeling sick very fast. Does anyone have an idea what it could be, so I can send my husband to the doctor and get it checked out. I am trying for over 6 months now to get him to go and he always says that there is nothing wrong with him, he just needs lots of water. Its about a year now that he drinks 15 liters a day, before it was a lot but only about half of right now. Thanks. Maria

23. sameenJanuary 23, 2012

hi! i am 21 years old girl and i'am overweight according to my bmi..i want to know that as i heard that drinking 12 glasses of water a day would be good as to loose weight like instead of having the unwanted meal on unimportant time...is that true?and is this any think concern with the acne with drinking too much water?

24. kybabyxoJanuary 23, 2012

Hi, so my brother had the same thing happen to him except he isn't overweight. He started drinking tons of water, almost a case of bottled water a day and he was 22 at the time. his tongue got really white like thrush. and he also was frequently urinating. he didnt think anything of it and he eventually had flu-like symptoms with vomiting and got weak. he passed out and when his friends took him to the er (as my mom and i were in a defferent state)they had told him that he has diabetes. im not saying that you have diabetes, but it wouldnt hurt to get it checked out. good luck to you :)

25. sharonbakerJune 9, 2011

I agreed with you that drinking too much water may lead to a various type illness in the body or may killing you...

http://www.raymeds.com/

26. Healthy4funAugust 31, 2010

How much water can a 96 pound person consume in a water drinking bet without causing harm to themselves?

27. Healthy4funAugust 31, 2010

What is the total amount of water a 96 pound person drink without causing danger to themselves?

28. CCASHKIERAugust 1, 2010

Wow! I am FREAKED OUT! I drink 100 ounces of water within the first three hours of waking up. I drink about 64 ounces before working out and then another 33 ounces during my workout. I continue to drink throughout the day as well, probably an additional 200 ounces..........I have always heard to drink a lot of water to lose weight. Advice? Opinions?

29. pradhangeorgeJuly 25, 2010

ERROR?"Every hour, a healthy kidney at rest can excrete 800 to 1,000 milliliters, or 0.21 to 0.26 gallon, of water and therefore a person can drink water at a rate of 800 to 1,000 milliliters per hour without experiencing a net gain in water, Verbalis explains. "....It is 1.5 - 2 liters of urine per day.# why at all shd anyone force drink water , when his thirst hydration/dehydration will tell him how nuch to drink? # water intoxication is as bad opposite as dehydration.

30. sctrbrnJuly 2, 2010

I have detoxed many for drug test so many times, and consumed ungodly amounts of water i have never had any problems other than frequent urination. Come on water killing us? Ridiculous! And how do you know the effect of overhydration with MDMA? Who's too say the combination wasn't deadly. I mean drink as much water as you want... dont chug it as a game... that is the furthest thing from logical thought. Millions worldwide do water cleanses and detox and drink extremely high amounts of water... And do we here of millions dieing? Hell No! Come on lets be a little objective.

31. uggbuggxMarch 29, 2010

I feel really I'll and vomiting always helps.I read that drinking lots of water could make you sick.if drank 3 litres and havnt been sick.could this be harmful ( I drank it all within 2 min)

32. uggbuggxMarch 29, 2010

I feel really ill and always fell better when I vomit. I read that drinking a lot of water could make you sick. it said to drink 2 litres at once, bit it wasn't working and I got abut carryed a way and drank 3 litres (within 2 mins) could this be harmful .( I still havnt vomited.)

33. codywalkMarch 22, 2010

Wynand,

I agree with the post below yours. It sounds like diabetes insupidus where your body doesn't produce enough ADH or vaspressin. See a health care professional immediately.

34. almilestelleNovember 15, 2009

My story

I had to drink water to prepare for pelvic ultrasound. I was drinking more (maybe 3x more than I should) so I will be super prepared. . Husband massaged my back and neck which hurts me for many years and we left for the ultrasound. Shortly after that I developed spliting headache (I never had headache before except some with cold) and vomited water just when we reached the place. We decided to go to hospital to find out what has happened. They gave me 4 pills of GRAVOL (never heard of it). It put me to sleep and I woke up in another hospital with diagnosis I am dying from tumour???? ).Operation did not make any sense to me but dr. can scare u to death so I surrendered, and effect is that I am suffering from OSTEOMYELITIS (staph bone infection), because "I was out of luck" I tried to get scan films and cd that I was shown in dr. office without success.. After three years of suffering without help I got news that I need to remove bone flap because it is to late for only antibiotic therapy. I don't know how long I will live but I try to survive without questionable operation. So please watch out outside is very dangerous world!!! Please pray for me.Thank You. If You know or heard of remedy for staph bone infection please let me know. Or myabe there is someone who had such an operation followed by cranioplasty and is cured from infection please let me know how it happened.

35. Wonderwoman1967August 14, 2009

Regarding tazguy's comment...yes, more people probably do die of dehydration. However, those are the people who most likely have a serious illness or do not have access to healthy, clean water. Most healthy people drink water when they feel dehydrated (or to put more simply, thirsty). One interesting thing, though, is that this 8-glasses-a-day phenomenon didn't start until corporations started selling bottled water. People thought it was absolutely silly for companies to sell bottled water and didn't "buy" into it. Then this "8 glasses a day" rumor started, along with the "supposed" environmental problems with our natural drinking water began...coincidence? I don't think so. People would like to think that bottled water is so much healthier (and in some other countries that may be true) but here, I don't think so. Just drink when you're thirsty, people...and although the water may not taste that great out of your tap because of the minerals, it's probably healthy (unless you live next to an industrial plant that leaks toxic waste, or near a farm where there is animal waste runoff). Everyone needs to get a grip, and stop carrying bottled water around like it's a little baby (and I live in the desert!). You're ruining the environment with your discarded bottles.

36. NakedApeAugust 10, 2009

Being thirsty all the time may be the body trying to flush out excess glucose. ie Diabetes. Get to a doctor ASAP!!!

37. NakedApeAugust 10, 2009

My brother had the same problem and it turned out he had diabetes. Please, get checked out by a doctor as soon as possible

38. inventor30July 13, 2009

I am personally acquainted with a person who is an obssesive drinker of sports drinks, and several times a year needs to go to ER and get sodium and potassium blood level restored , as these minerals are excreted along with the water from the kidneys.

39. Egyptian ThunderJune 16, 2009

i like how you think. i strongly agree with your answer. water is gods gift and this person is a fraud. she committed suicide.

40. Egyptian ThunderJune 16, 2009

wow i never realized that too much water can kill you. i feel like i have been drinking a lot lately. i think i have to cut down on it.

41. unblocktheplanetJune 7, 2009

Drinking lots of water and avoiding alcohol have also been given as advice to users of Ecstasy. In several confirmed instances, including the death of Australian mid-teen poster girl on the dangers of Ecstasy, it was determined that users had overhydrated, resulting in water intoxication. They died from water, not E.

42. ehs284June 5, 2009

A few years ago I ran a health promotion module at university in which students chose a method of improving their health and monitoring changes. Exercise, stopping smoking etc were obvious areas, but one lady was a very fit 40 year old who neither drank nor smoked, walked 10 miles a day and was vegetarian. Her weight was low normal BMI. After talking about 'vices', the only thing capable of changing was her consumption of lemonade (soda) which was about 2 litres a day whilst she was working.

We decided to try changing the lemonade for water. A week later she was happy, fit and had lost a little weight. Two weeks later she'd lost a little more weight...and so on. After a month I was worried about her continuing weight loss and at that point she admitted that she was not feeling too well, being occasionally dizzy. A little more quizzing and she said that she was sipping water through the day and consuming about 8 or 9 litres a day. She was addicted to water drinking. We had to work out a way of weaning her off the habit and it took a month before she was back to her normal self.

43. Julie12362April 30, 2009

Has for having the need to drink copus amounts of water, I would have to agree see a doctor ASAP, this could be a sign of Diabetes lurking in the shadows. This I no because I am a type 1 diabetic of 37 years. Good luck.

44. RenoRomeFebruary 1, 2009

Your symptoms could suggest diabetes. I would definitely consult a physician for a glucose tolerance test. Or, if you know someone who has a blood glucose meter, you could monitor this on your own. Your blood sugar level should be, on average, between 70 - 110. However, I would highly recommend a healthcare professionals opinion.