Bushwalker dies after drinking too much water

[wayno]

avoid refined sugar and fructose if you can , it's acidic, any acidic food or drink hinders exercise and recovery. go for dried fruit or something with carbohydrates. "energy drinks" are extortionately expensive for what they are, they contribute to tooth decay , theres a massive problem with the no's of people experiencing tooth decay from drinking energy drinks and "sports water" dont think low levels of sugar in fluids will be any better for your teeth. they are still bad.
if you must drink sugary fluid regularly you also need straight water to flush any remaining sugar out of your mouth

[Strider]

I still stop to drink due to me using wide mouthed nalgenes (they would spill if I was walking)

Solution:
https://www.guyotdesigns.com/splashguards/

camelback do nalgene bottles with a sip tube at the top that self closes

They are Camelbak bottles, not Nalgene. Apparently popular, but the idea of sucking on a dirty straw doesn't appeal to me.

[wayno]

they have removeable mouthpieces made of silicon rubber can boil and steralise them

[Pongo]

Thanks for the tips guys.

I must say I think I've already fallen in love with the smiley sipper here: https://www.guyotdesigns.com/splashguards/ Now do I pick up the cammo one for my army mate?

[Ent]

One interesting side note to that story is the comment that with a walking partner the death may well have been avoidable. The terrain was not overly hostile nor the walker underdone on equipment and experience yet the result was tragic.

Regards

[wayno]

perhaps administering salt to him if someone was with him, might have saved him

[walkinTas]

I am still struggling with aspects of this story. I guess I'm a bit shocked that this can happen on a 4 hour bushwalk in Tasmania in April. Especially when ... "Mr Dent was in apparent good health, and well equipped for the walk. He was wearing appropriate clothing and was carrying a day pack which contained among other items, ...food .... He was carrying a one litre bottle of water. He believed that that would be sufficient for the planned walk...."

The actual coroner's report make interesting reading. "....the evidence leads to the conclusion that death has resulted from a condition described as exercise-associated hyponatremia (EAH). The condition consists of a dilution of serum sodium which occurs during or up to 24 hours after prolonged (greater than 4 hours) activity...". Another interesting comment " In EAH the urine volume is minimal..." (water retention).

I guess my "shock" comes from learning that something like this can happen after just 4 hours of walking. EAH is something I would have associated with "extreme" exercise, not with a 4 hour bushwalk. I'm hoping this case will lead to more research and more discussion.

[Wolfix]

This is the same fate that befell Anna Wood. She had taken MDMA and was an unlucky user who suffered another syndrome which meant when she took MDMA she didn't excrete excess fluid effectively. I guess this means she didn't urinate when she needed to, or sweat. Perhaps this man also suffered the syndrome and the Coroner did not pick it up, or he had a predisposition to Hyponatraemia which it seems he may have.

Another woman suffered a similar fate in the Boston Marathon in 2002 and there are interesting articles online about this and other deaths from Hyponatraemia which suggest that frequent dehydration could lead to a depletion of sodium in the bloodstream but not in the cells, so when salts are replaced (through sports drinks for example) the cells flood themselves to clear out excess sodium and then the cerebral oedema occurs.

In any case, this is very rare and quite possibly related to a pre-existing condition and I would suggest bushwalkers should be more concerned about dehydration, heatstroke, hypothermia and venomous bites than Hyponatraemia.

[walkinTas]

Here is another interesting read. It is a long and heavy read, but it has lots of interesting facts.

"Almond et al. (15) were not able to find a correlation in the type of fluids consumed (water versus electrolyte-containing solutions) and the subsequent development of hyponatremia. Other studies also have shown that the consumption of a carbohydrate/electrolyte-containing sports drink does not protect against the development of hyponatremia (35–38). This likely reflects the relative hypotonicity of most of the commercial sports drinks in which the sodium concentration typically is 18 mmol/L (39). "

"Current evidence strongly supports that EAH is, in large part, dilutional in nature. In the majority of athletes who develop hyponatremia, there is an increase in TBW relative to that of total body exchangeable sodium (34). As described previously, this seems to occur by the ingestion of hypotonic fluids (water or sports drinks) in excess of sweat, urine, and insensible (mainly respiratory and gastrointestinal) losses."

"...several general recommendations for the prevention of EAH have been made (14,95–98). The first is to drink only according to thirst and no more than 400 to 800 ml/h (95). The higher rates of fluid intake would be recommended for runners with higher rates of exertion.... Currently, there is insufficient evidence to support the suggestion that ingestion of sodium prevents or decreases the risk for EAH; neither is there any evidence that consumption of sports drinks (electrolyte-containing hypotonic fluids) can prevent the development of EAH (1,35–38,42,100,101)."

[ILUVSWTAS]

In any case, this is very rare and quite possibly related to a pre-existing condition and I would suggest bushwalkers should be more concerned about dehydration, heatstroke, hypothermia and venomous bites than Hyponatraemia.

Spot on imo.

[nq111]

In any case, this is very rare and quite possibly related to a pre-existing condition and I would suggest bushwalkers should be more concerned about dehydration, heatstroke, hypothermia and venomous bites than Hyponatraemia.

Spot on imo.

+ 2

[andrewa]

+3, Wolfix.

In day to day medicine, I am v aware of hyponatraemia ( low sodium levels) , but don't see significant hyponatraemia that often. In my practical experience, it occurs most often in patients on diuretics ( fluid tablets), and is reported, but I've not seen it, in pts on SSRI type antidepressants. Blood sodium levels are normally 135 "units per fortnight", or higher. They need to drop to below 125 before pts start getting some symptoms, and below 120 is cause for turfing to hospital, if the pt has symptoms.

I've never come across exercise induced low urine output hyponatraemia. The Anna Wood issue I can understand. Party drugs increase serotonin levels in your brain, and stimulate your thirst centre. Hyponatraemia, here we come.

The likelihood of a normal plod mode bushwalker developing it is small. Watch out for snakes, 4WD, and lightning first.

A

[clarence]

+4.

I was very concerned when the radio news stated that a bushwalker died from "drinking too much water". Such simplistic statements witout qualification can be dangerous.

I think a knowledge of a few important facts are worthwhile, and at the very least will help any active/outdoors person understand the issues a little better. To make broadbrush rules like "drink less water" etc can be very misleading without a knowledge of some underlying facts.

-The body can only absorb approximately 1L of water every hour, no matter how much you can physically get into your stomach

-A very active body can sweat over 2L of water per hour
(Therefore even with regular fluid consumption it is possible to DEhydrate. I agree with Wolfix that the danger of dehydration pr0bably is a more significant risk in most cases).

-Sweating causes loss of salt from the body, as the body excretes salt as part of the sweating response.

-The sweating response (temperature at which sweating commences and the salt concentration of the sweat) and hence the way the body manages fluid and salt/electrolyte changes substantially during acclimatisation.

-Acclimatisation takes about two weeks to occur fully, and requires activity in the "new" environment, not just being exposed to it

-At higher humidity sweating becomes less effective as the atmospheric concentration of moisture is so high that it is harder for the water to evaporate from the skin. Hence one can sweat substantially but not cool down much at all in high humidity conditions.

-Regulation of the levels of exertion are equally as important as water and/or electrolyte intake in hot/humid environments and for those acclimatising or adapting to more intense exercise regimes.

Clarence

[tsangpo]

In terms of what is the best electrolyte replacement I did DSE fire fighting crew as a summer job for 3 years in Victoria and and we had Staminade as the electrolyte replenisher and it was supposed to be drunk in a 1:4 ration with water. Also based on experience from marathon x/c ski races and triathlons Staminade was the drink station drink of choice (this may have been just through sponsorship though).

[wayno]

with some nutrients the body can be slow to regulate a particular nutrient when circumstances change, i'm not sure if it can happen with sodium, but it can happen with vitamin c for instance. you take high dose vitamin c then stop taking it al together, the body will flush out the high dose of vitamin c rapidly in teh urine, but it is slow to reduce the amount being peed out when the intake stops and in some cases people pee out vitamin c till they get a reactive scurvy condition, they get low vitamin c.
perhaps this could happen with sodium? perhaps this gent normally excretes a lot of sodium in his urine, he's only drinking and not taking sodium in for several hours and his urine output is high for those four hours? and the body doesnt stop discharging the urine, combine that with salt in sweat... your adrenals have to be working correctly to correctly regulate sodium, maybe he had another underlying medical condition that made him prone to low sodium levels... assuming that was the contributing factor to his death.
normally you'd expect hyponatremia in cooler environments where people arent loosing as much water , sweating isnt necessarily an issue with hyponatremia the water can dilute the sodium levels enough on its own.
i've seen someone collapse and die after a half marathon, young fit, healthy looking adult. heart stopped, no previous medical conditions, i dont think they found out why she died. endurance exercise can do that on rare occasions and the reasons arent always clear....

[Tony]

In terms of what is the best electrolyte replacement I did DSE fire fighting crew as a summer job for 3 years in Victoria and and we had Staminade as the electrolyte replenisher and it was supposed to be drunk in a 1:4 ration with water. Also based on experience from marathon x/c ski races and triathlons Staminade was the drink station drink of choice (this may have been just through sponsorship though).

Hi tsangpo.

This is from the AIS Fluid - Who Needs It? fact sheet, as far as I am concerned there is not much difference between Gatorade, Powerade and Staminade Sport, we are all different and it is a personal preference of what works for you.

Drink, CHO (%), Sodium (mmol/L)

Gatorade, 6 , 18

Powerade, 7.6, 12

Endura, 6 , 14

Staminade Sport, 7.5, 14

PB Fluid &Electrolyte Replacement, 6.8, 25

Tony

[wayno]

some have other minerals or vitamins in them too. like potasium and b vitamins
b vitamins can give you an energy hit but are diuretics and i find my energy goes up then crashes when i have too much... depends on how much is in them.

[Tony]

normally you'd expect hyponatremia in cooler environments where people arent loosing as much water , sweating isnt necessarily an issue with hyponatremia the water can dilute the sodium levels enough on its own.
i've seen someone collapse and die after a half marathon, young fit, healthy looking adult. heart stopped, no previous medical conditions, i dont think they found out why she died. endurance exercise can do that on rare occasions and the reasons arent always clear....

Hi Wayno,

It does not need to be cold to suffer from hyponatremia, this article is about Over-hydration 'hazard for Kokoda hikers'

Also a condition called Rhabdomyolysis which is muscle meltdown which they think can happen from dehydration and over heating.

This is a case if Rhabdomyolysis where I kept the newspaper cutting, I do have a cutting from a case of muscle meltdown in Wagga where the person lived, but I am unable to find it at the moment.

IMG_6219.jpg (152.87 KiB) Viewed 9635 times

IMG_6220.jpg (139.12 KiB) Viewed 9635 times

Tony

[wayno]

my understanding of sodium in the body, is it tends to occur in high amounts outside the cells in the bloodstream and in between the cells but at lower levels in the cells. water has a strong afinity for sodium so the sodium is keeping a fluid balance in areas outside of the cells. when sodium levels drop, the water doesnt have the sodium there to hold it outside the cells and it then moves into the cells, the problem area being the brain and swelling.

[wayno]

an nz sas soldier collapsed and went into a coma for several days last summer, training in the hills near auckland, cause unknown, temperature was in the twenties, humidity in the 90's. he would have been wearing long trousers and possibly a long sleeved top. he was carrying a heavy pack

[bluewombat]

For those interested in the issues around hyponatremia there will be a segment on the Tasmanian version of the ABC 7.30 report this Friday
bw
ps exertional rhabdo and hyponatremia are quite separate issues

[wayno]

i became rather sick once, was too nauseous to eat. was peeing dark urine. so i drank water. urine was still dark
i drank a litre of water an hour every waking hour, still passed dark urine, couldnt eat
this went on for a couple of weeks. i was drinking a good 14 litres of water a day for the two weeks....
wasnt eating... in the end i had to force myself to eat and gradually regained my appetitie
so despite 120 litres of water and no salt intake i didnt die from drinking too much.
cetainly not something i'd recommend doing, and i didnt intend to set out to be so extreme.
but as long as my urine was dark and i felt sick , i felt it was better to keep drinking as there was something my body was trying to get rid of..
why i didnt go to a doctor is a long story, i had chronic fatigue at the time and the doctors were all patronising and i was in a hard headed mood to tough it out being young and hard headed.... if i thought my life was in really danger i would have sought medical help. perhaps it was and i was too stupid to realise at the time..
so after that episode i'd be surprised if many people would die from drinking four litres of water unless they were sweating great amounts at the same time.
i just drink more according to thirst now, maybe a third of a litre an hour on a hot day. maybe a couple of hundred mls on a cool day i find does me fine.
actually come to think of it, i did an eight hour trip on a hot day where i drank four lites, i had to climb a vertical mile on a steep pass but i did eat a bit of food although it didnt have nearly enough sodium in it to replace what i was sweating. didnt notice anything out of the ordinary at the end of that day other than hunger and general tiredness. so i'd say the gent to passed away after drinking four litres had something else going health wise on to increase the likihood of death.

[tasadam]

There is a topic here on the forum discussing Hyponatraemia
Surprised nobody has linked it yet, there is some info in it too - viewtopic.php?f=5&t=4226

[madmacca]

perhaps administering salt to him if someone was with him, might have saved him

Or perhaps someone just saying to him "Mate, you're suffering from overhydration, not dehydration". Or even if he was solo, just understanding the body's real hydration needs.