Water intoxication resulting in ventricular arrythmias

Abstract

Water intoxication defined as excessive water ingestion within a short period of time may cause severe neurologic and cardiac symptoms. This condition is commonly seen in psychiatric patients, however ingestion of excessive water is a infrequent way for attempting suicide. In this case report we present a 51 year old women with ventricular fibrillation due to electrolyte imbalance caused by excessive water ingestion for attempting suicide. Patient was admitted to our emergency clinic with altered consciousness and agitation. She was hypertensive and neurological examination revealed no lateralizing sign. Ventricular arrhythmias, cardiopulmonary arrest and tonic-clonic seizure were observed during hospitalization. Blood chemistry showed hyponatremia and hypokalemia relevant with patient's history of ingestion of 12 liters of water in 4 hours time. After electrolyte disturbances were corrected, ventricular arrhythmias and seizure did not recur. Patient was referred to psychiatric evaluation and was discharged with antidepressive medication. Although water intoxication is well described in psychiatric disorders such as schizophrenia, it is not previously reported in depressive patients with suicidal thought. Being aware of clinical presentation of this rare situation may prevent potentially fatal complications.