Telling people to 'drink plenty of fluids' when unwell could be dangerous, doctors have warned.
Experts
at King's College Hospital in south London questioned the
recommendation after treating a 59-year-old woman who drank so much
water that she became gravely ill.
The woman, who is not
named, overdosed on water after developing symptoms of a urinary tract infection.
She recalled
being told by a doctor previously to drink lots of water - half a pint
every 30 minutes - though she said she thought in this case, she had
consumed more to 'flush out her system'.
The woman was admitted to A&E, where doctors found she was suffering from dangerously low levels of salt in her blood.
This can occur if too much water is drunk over a short period of time.
Symptoms
include nausea, vomiting and headaches. In serious cases, the brain can
swell, which can lead to confusion, seizures, coma and death.
A death rate of almost 30 per cent has been reported in patients with abnormally low salt levels.
Writing in the journal BMJ Case Reports, doctors said there was little evidence to know how much water is too much.
They
described how their patient woman got worse after she arrived in
hospital, writing: 'During her visit to the emergency department, she
became progressively shaky and muddled. She vomited several times, was
tremulous and exhibited significant speech difficulties.'
Doctors
were able to save the woman's life with treatment including restricting
her fluid intake to a litre over the next 24 hours, but they said on
another occasion a young woman suffering from gastroenteritis died after
consuming too much water.
The
patient, writing of her own experience in the same journal, said: 'I
lost 24 hours of my life when a simple UTI, or rather my actions in
response to it, took over my life.
'I
remember seeing my hand in front of me shaking rather violently and I
wondered why I could not stop it, then realised that my whole body was
shaking.'
She spent 24 hours in hospital - long stretches of which she cannot remember - before she was discharged.
'It took about a week to feel 'normal' again and if I am honest I think I was tired for at least another week,' she wrote.
People who take the drug MDMA and those taking part in endurance sports are also at risk of very low salt levels.
The
doctors - Dr Laura Christine Lee and Dr Maryann Noronha - wrote: 'We
frequently advise our patients to 'drink plenty of fluids' and 'keep
well-hydrated' when they are unwell.
'But, what do we mean by that? Are there potential risks of this apparently harmless advice?
'As
demonstrated here, the harmful effects of increased fluid intake
include confusion, vomiting and speech disturbance, and potential for
catastrophic outcomes due to low blood sodium concentrations.'
They
concluded: 'There is a paucity of evidence behind the advice to "drink
plenty of fluids" in the management of mild infective illness.'
But
Dr Imran Rafi, chairman of clinical innovation and research at the
Royal College of GPs, said: 'Drinking enough water is important in
keeping healthy, both physically and mentally, and patients should keep
their fluids up when unwell, particularly in conditions that can cause
dehydration.
'We
would encourage patients to drink more if they have symptoms of
dehydration, such as feeling thirsty - including in hot weather or when
exercising - or passing dark-coloured urine. There is no steadfast
recommendation as to how much water people should drink in order to stay
healthy, but the key thing is to keep hydrated - and passing clear
urine is a good indication of this.
'This
case report highlights that excessive water intake can have important
consequences for patients, and this is something that healthcare
professionals, and patients, should be mindful of.'
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