A truly pointless way to die

After competing in a water-drinking contest to win a Wii for her children, a young mother died of water intoxication:

SACRAMENTO, California (AP) — A woman who competed in a radio station’s contest to see how much water she could drink without going to the bathroom died of water intoxication, the coroner’s office said Saturday.

Jennifer Strange, 28, was found dead Friday in her suburban Rancho Cordova home hours after taking part in the “Hold Your Wee for a Wii” contest in which KDND 107.9 promised a Nintendo Wii video game system for the winner.

“She said to one of our supervisors that she was on her way home and her head was hurting her real bad,” said Laura Rios, one of Strange’s co-workers at Radiological Associates of Sacramento. “She was crying, and that was the last that anyone had heard from her.”

It was not immediately known how much water Strange consumed.

A preliminary investigation found evidence “consistent with a water intoxication death,” said assistant Coroner Ed Smith.

John Geary, vice president and marketing manager for Entercom Sacramento, the station’s owner, said station personnel were stunned when they heard of Strange’s death.

“We are awaiting information that will help explain how this tragic event occurred,” he said.

Initially, contestants were handed 8-ounce bottles of water to drink every 15 minutes.

“They were small little half-pint bottles, so we thought it was going to be easy,” said fellow contestant James Ybarra of Woodland. “They told us if you don’t feel like you can do this, don’t put your health at risk.”

This is just a reminder. Your kidneys are wonderful organs. In a young, healthy person, they are amazingly efficient at getting rid of excess free water (free water is water without electrolytes) and regulating the electrolyte balance in the blood. However, as amazing as your kidneys are at doing this, they do have their limits. Healthy kidneys can only excrete a maximum of around 1 liter of free water (or slightly more) per hour. Age and disease will decrease this capability. This particular contest had people drinking approximately 250 ml of water every 15 minutes, or 1 L per hour, which is at the capability of most people’s kidneys to eliminate. Now, drinking 1 L of water in an hour won’t hurt most people (lots of people, including me, do it), but drinking 1 L per hour for multiple hours might, and the story above says that after one hour contestants were given even bigger bottles to drink.

Criminal stupidity!

What probably happened is that this woman developed a dilutional hyponatremia (low sodium concentration in the blood), because she was drinking water without any electrolytes in it. The normal level of sodium in the blood is 135-145 mmEq/L. Although below a sodium of 120 mEq/L, hyponatremia is considered life-threatening, the body can adjust to fairly impressive levels of hyponatremia (in the 120’s or even lower) when the hyponatremia develops slowly. It can’t do so well when hyponatremia develops rapidly, as it almost certainly did in this case. Because cell membranes are freely permeable to water but impermeable to electrolytes like sodium ion except by special ion transport channels, what happens in these cases is that water flows from areas of low electrolyte concentration (the serum) to areas of high electrolyte concentration (inside the cells) to equalize the electrolyte concentrations. (This is called an osmotic gradient.) This results in swelling of the cell, even to the point of rupturing the cell membranes. In the brain, this causes cerebral edema, with catastrophic and often fatal results. In addition, the kidney, to get rid of that free water, is physiologically obliged to excrete small amounts of other electrolytes, including magnesium, and low magnesium can lead to cardiac arrest. It is not revealed how large a woman Strange was, but I’d be willing to hazard a guess that she was probably fairly small, so that it took less water than it would in a muscular young man to result in such an outcome.

One can only hope that such a criminal level of ignorance and negligence results in appropriate penalties. Allthough I do not discount individual responsibility, most people are ignorant of how little it can take to cause water intoxication. It is not stated whether (1) contestants were warned that they could die from drinking too much water too fast or (2) qualified medical personnel were present to monitor the contest. In addition, it doesn’t say whether the radio station had vetted its idea with a physician. I doubt that it did, because any competent physician would have told the organizers that this contest was a very bad idea and dangerous, to boot. Given this, the radio station showed an uttterly reckless disregard for the safety of the contestants.

(Hat tip to GruntDoc, Pharyngula, and Retrospectacle, plus readers who sent me links to this story this afternoon.)