Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review
Rangan GK, Dorani N, Zhang MM, Abu-Zarour L, Lau HC, Munt A, Chandra AN, Saravanabavan S, Rangan A, Zhang JQJ, Howell M, Wong AT
BMJ open · 26 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- University or hospital
- Western Sydney Local Health District
- University or hospital
- University of Sydney
- Nonprofit
- PKD Australia
- Government
- Medical Research Council
- Government
- National Health and Medical Research Council
- Authors
- At least one author declares a financial tie to industry
- Grants
- National Health and Medical Research Council (1138533); National Health and Medical Research Council (1164128)
Based on 5 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2021-12-01 · BMJ Open · vol. 11 · issue 12 · p. e046539
- Publisher
- BMJ
- Cited
- 36 citations · more than 81% of similar papers · 1.3× the field average
- References
- 243 works
- Access
- Open access (journal) · CC-BY-NC
- Research areas
- Electrolyte and hormonal disorders · Thermoregulation and physiological responses · Sodium Intake and Health
- Keywords
- Medicine, Epidemiology, Intensive care medicine, Public health, MEDLINE, Environmental health, Internal medicine, Pathology
- MeSH
- humans, hyponatremia, chronic disease, water, saline solution, hypertonic, drinking, adult, middle aged, female, male
12 authors
From AU
- Gopala K. Rangan · correspondingWestmead Hospital; Westmead Institute for Medical Research
- Nilofar DoraniThe University of Sydney; Westmead Institute for Medical Research
- Miranda M. ZhangThe University of Sydney; Westmead Institute for Medical Research
- Lara Abu-ZarourThe University of Sydney; Westmead Institute for Medical Research
- Ho Ching LauThe University of Sydney; Westmead Institute for Medical Research
- Alexandra MuntWestmead Hospital; Westmead Institute for Medical Research
Abstract
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).
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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