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Author Topic: Too Much Water (Sad Facts)
ClaudiaTherese
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Woman dies of "water intoxication" after radio station contest for a Wii

Unfortunately, you can drink to much water, although it takes a lot of effort. If you drink too much water, it flushes out the concentrating gradient in the kidneys. End result = can be cerebral edema (brain swelling, up to the point where it herniates down the brainstem and kills you).

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cmc
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Saw that... What I'd like to know is: how much did she drink in how long a time period? We used to make jokes during softball or soccer games about how we were going to die of too much water and we were always reassured that it'd take A LOT.

What a bummer. What a bummer for her kids, too.

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Lyrhawn
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I saw this on the news the other day and thought it would make an apperance on here.

It's sad. [Frown]

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quidscribis
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quote:
Initially, contestants were handed eight-ounce bottles of water to drink every 15 minutes.
quote:
After he quit, he said, the remaining contestants, including Ms. Strange, were given even bigger bottles to drink.
Which doesn't tell us exactly how much she drank, but does provide a bit of a clue.

It also makes me wonder how much water is too much.

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rivka
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I hope her family sues the station. That contest was an idiotic and dangerous stunt (as all too many radio station contests are).

I also can't decide if this is more or less tragic than the people who manage to die of water intoxication trying to fool a drug screen.

Horrible. [Frown]

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Lyrhawn
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I'd say more tragic, if you're being forced to make such a judgement.

Taking drugs and hiding it is selfish, entering this contest to try and win her kids a game system is selfless, all the more so since she literally died in the effort.

And from WebMD
quote:
You would need to chug down about three quarts of water or more all at once to come down with a case of true water intoxication. It does happen, but so rarely that I couldn't find statistics on the number of cases. These people become drowsy, lightheaded, and weak. They have trouble coordinating bodily movements and thinking straight, looking and feeling as if they just stumbled out of the local bar. But the water-intoxicated can't just go home and sleep it off. They must get treatment or risk going into convulsions, a coma, or even death.
From an article on a 14 hour ironman competition.

quote:
The authors emphasize that the patient drank "excessive" amounts of fluid -- averaging approximately 1.64 liters per hour throughout the event. They suggest that drinking fewer fluids overall, and drinking fluids that have sodium such as many sports drinks, could have prevented the man's severe condition.



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Tante Shvester
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The radio station is responsible, I think. This woman didn't understand the risk. Horrible, horrible story. Senseless death. Oy.

I listen to NPR. I can't stand the other idiot stations.

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Juxtapose
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Clearly the radio station personnel didn't understand it either. It's certainly nothing I've ever heard about, nor is it something I would have thought to check on. They're probably liable, but I can't help feeling bad for whoever organized this. They weren't trying to kill anyone.
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quidscribis
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I agree with Juxtapose. I doubt the station had a clue, given how rarely this seems to happen. It's an all-round sucky thing to have happen.
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rivka
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quote:
Originally posted by Lyrhawn:
I'd say more tragic, if you're being forced to make such a judgement.

Taking drugs and hiding it is selfish, entering this contest to try and win her kids a game system is selfless, all the more so since she literally died in the effort.

Good point.


I agree that the radio station personnel did not do this with malice aforethought. However, they were negligent, IMO criminally so. And as I said before, that is hardly unique. There are many radio station contests that I have heard of over the years that I am sure no one had the forethought to run by a medical doctor for an opinion on potential hazards.

It's not even the first time someone has died from participating in a radio station contest.

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cmc
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Thanks for the info, Lyrhawn + quidscribis.

I agree that the station is responsible, if not from a legal standpoint (waivers being signed and all) but from a humane standpoint. The winner is quoted as saying that she and the other woman were puking and feeling sick in the bathroom together. Hindsight, being what it is, maybe the radio station personnel should have done a little more research into what MIGHT happen - and then how much is too much and what some warning signs are.

I'm not saying anyone should try to sue, just that it's sad that no one even recognized the possibility that the contest could turn tragic.

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Lyrhawn
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I'm sure there WILL be a lawsuit, it's how these things work.

I think they are responsible insofar as when you hear about a competition like this on the radio, you ASSUME that you won't DIE from it. It's that inherent trust that was breached through their negligence. I don't know what price they should pay, but I agree that a heavy burden lies on them for this.

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cmc
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Were they a CC station? If so - they'll probably settle, probably for lots of $$ if there's a suit.
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MightyCow
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I saw a 20-20 or 60-Minutes show a few months back about a Frat hazing where the same thing happened, and a kid died of water overdose.

I always kind of wonder if you can get meat poisoning. Those places where you have to eat a 6.lb T-bone in one sitting frighten me.

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Little_Doctor
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I hope they gave the Wii to her kids.
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erosomniac
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I hope the people who produced the contest feel morally responsible, but I sure as hell hope they aren't held legally responsible for this.
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DDDaysh
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You can get poisoned by ANYTHING in too high a quantity. I'm sure if you ate too much meat you could get iron poisoning. However, with water, it's not exactly that the water poisons you, it is that processing it takes out too many minerals from your body. This will only happen if you're doing something like chugging it in a contest, if you're thirsty, you'll never drink too much.
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Lyrhawn
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Tell that to the guy in the iron man contest.
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rivka
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quote:
Originally posted by Little_Doctor:
I hope they gave the Wii to her kids.

I hope they didn't! "Hey, let's play with that toy Mommy died for!" "Yay!"

quote:
Originally posted by erosomniac:
I hope the people who produced the contest feel morally responsible, but I sure as hell hope they aren't held legally responsible for this.

Why? They should be legally responsible to have done due diligence -- and there is no evidence that they did. Seriously, all they had to do was ask a doctor, "Could this be dangerous? What health problems could it cause?" Resisting the urge to urinate can damage the urinary system, water intoxication aside.


quote:
Originally posted by DDDaysh:
I'm sure if you ate too much meat you could get iron poisoning.

Highly doubtful. Your cholesterol and serum triglyceride levels would probably not look so hot. And all that excess protein would probably put a strain on your kidneys, among other things.
quote:
Originally posted by DDDaysh:
This will only happen if you're doing something like chugging it in a contest, if you're thirsty, you'll never drink too much.

Not true. If you are thirsty because of dehydration due to sweat loss (or crying), you absolutely can drink too much plain water -- you should hydrate with water with sugar and/or salt. (Or Gatorade/Powerade, which is much the same thing.)

(Or, what Lyrhawn said.)

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Frisco
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Couldn't we shift just a little bit of blame to the woman who didn't bother to simply figure out if this was safe to do?

Really. Who's stupid enough to enter a contest of extreme excess without doing the simplest homework. You can bet that if I ever go off and do something extremely dumb for money that I'm going to figure out whether or not it's possible to die from it.

Pretty irresponsible on the woman's part.

(Darwin Award finalist?)

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rivka
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quote:
Originally posted by Frisco:
Pretty irresponsible on the woman's part.

(Darwin Award finalist?)

Agreed. Except since she already reproduced, does she qualify for the DA?

Just because she was irresponsible doesn't mean the radio station wasn't.

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Strider
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Frisco has a point. More accurately a blunt object to the head...but regardless, I don't think it's fair to completely blame the radio station. At what point do people stop being responsible for their actions and we shift over to blaming other people for their actions? Can we sue her husband for being negligent and letting her go on the show?

While I do think the radio station takes more responsibility for hosting the contest, I don't think a law suit would be "justice".

edit - just wanted to add, it sucks this person died like this, I don't want to make light of that.

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cmc
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Here's me, playing 'Average Joe'.

If I hear about a contest, for drinking water, on a radio station, the prize being something my kids really want... I'm going for it. Shoot - all I have to do is drink water!!

Here's me, playing 'Average Radio Station'.

We've got a cool thing to give away. What's a simple contest we can hold to give it away? How can we make it funny? How can we be sure it'll translate through sound only? How can we make it dumb enough that people will keep listening, or at least checking back?

Here's my long-winded point.

Yeah. They both didn't go far enough into checking out what they were getting into. She should have made sure it was only drinking water. That there was nothing else it could be other than drinking water and calling it a day. The radio station should have made sure that something they were hosting was only drinking water. That there would be nothing else than some people drinking some water, giving away a cool thing and calling it a day.

Both situations suck to be in. Imagine being the person who thought up the contest? It all sucks. Even though it sucks, I still don't see any good coming of a law suit. What - so it can sit in the front of your mind everyday until it's settled?

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rivka
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No. So that other radio stations will think twice before having similarly idiotic contests without checking out potential ramifications.

Also, their actions caused her death. Nothing can make up for her loss. But the money can help with the financial hit her family will have to deal with as a result of her death.

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BlueWizard
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I think if the Radio station is promoting this event there is the implication that they have researched it, and determine HOW to keep it safe.

I've seen radio station have contest where to get a prise you had to dive into a small pool full of wet cow DUNG. My first thought was did they sterilize the cow dung first. If the cow dung came from a home supply store then it had almost surely been steamed and therefore was organically inactive; in other words, reasonably sterile.

However, if the cow dung came straight from a farm, then there probably was a very high potential of organic contamination that very easily could put your health at risk.

Again, my point is, that by putting on a public contest there is a reasonable expectation that the radio station has done some research and found a way to make the contest reasonably safe.

True there is always an element of personal responsibility, and if this is a civil case, the jury should weigh the responsibility of each party and offset the settlement based on the an evaluation of those responsibilities.

Just a thought.

Steve/BlueWizard

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ClaudiaTherese
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quote:
Originally posted by cmc:
She should have made sure it was only drinking water. That there was nothing else it could be other than drinking water and calling it a day. The radio station should have made sure that something they were hosting was only drinking water. That there would be nothing else than some people drinking some water, giving away a cool thing and calling it a day.

The problem is that in this case, it was the drinking just water that killed her.

Regardless of whether or not she had urinated or held it in, it was the actual processing of that much water through her kidneys [or rather, not processing it -- too much to fast diluted her blood out faster than her kidneys could keep up, and so her brain swelled to compensate for the osmotic force differential] that killed her. It had nothing to do with holding it in.

[ January 16, 2007, 10:15 AM: Message edited by: ClaudiaTherese ]

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ClaudiaTherese
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quote:
Originally posted by BlueWizard:
I think if the Radio station is promoting this event there is the implication that they have researched it, and determine HOW to keep it safe.
...
Again, my point is, that by putting on a public contest there is a reasonable expectation that the radio station has done some research and found a way to make the contest reasonably safe.

Indeed. And the radio station puts on stunts like these to drum up listenership and increase ad rates. The station financially benefits from contests set up like this, and so they incur additional responsibility for how they obtain that money.
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Dagonee
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Quick question. If someone were to be vomiting and having liquid bowel movements for, say 12 hours and had drunk about 3 16-oz glasses of water in that time, some in slow sips, some in injudicious gulps, and had definitely ejected more than that amount of liquid in the interval, would that someone be in danger of something like this?

And, if so, how should it be avoided?

(I'm calling the advice nurse, too, but everything I found on the net said one could wait 24 hours after such incidents start for adult patients.)

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Dagonee
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On the law suit issue, for better or worse, we have created a system of private enforcement for dangerous, non-criminal behavior in this country. That is, we expect injured persons to present their case, a judge to rule if such a case is worthy of reimbursement, defendants to demonstrate why it is not, and juries to determine the facts. This would not be a frivolous suit, and, lacking such a suit, there is almost no way to put stations on notice that have a duty to investigate and inform participants of the danger of their stunts. I have not determined if I think the station should be liable yet, but I have no problem saying a law suit over this is non-frivolous and not inherently harmful.

BTW, I'm sure there was a waiver of liability; it's not ever clear if such a waiver is enforceable (although one should assume it is whenever one signs one).

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dkw
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The WebMD article said you'd have to chug three quarts of water all at once. That's a long way from a quart and a half over 12 hours.

3 sixteen oz glasses doesn't even get you to the recommeded daily intake.

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ClaudiaTherese
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Dag, what dkw said. And if this person were to drink things with electrolytes (e.g., soup, gatorade, etc) or eat some things with salt, then this would help replenish electrolyte stores.
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Dagonee
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I've been put on diluted Gatorade and saltines until my doctor's appointment at 2:30. [Smile]

Thanks, dkw and CT.

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ClaudiaTherese
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[Big Grin]
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rivka
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quote:
Originally posted by ClaudiaTherese:
quote:
Originally posted by BlueWizard:
I think if the Radio station is promoting this event there is the implication that they have researched it, and determine HOW to keep it safe.
...
Again, my point is, that by putting on a public contest there is a reasonable expectation that the radio station has done some research and found a way to make the contest reasonably safe.

Indeed. And the radio station puts on stunts like these to drum up listenership and increase ad rates. The station financially benefits from contests set up like this, and so they incur additional responsibility for how they obtain that money.
Agreed, with both of you.



Diluted Gatorade has another name. It's called Pedialyte. [Wink] Feel better, Dags.

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mr_porteiro_head
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I was in the jury pool a couple of years ago for a man and woman who were charged with child abuse murder. As a punishment for stealing juice from her sister, they forced their little girl to drink a lot of water, which ended in her death.

I felt really sorry for them* because by all acounts, they were trying their best to raise a really difficult child, and were following the advice of child therapists.

*Note that feeling sorry for them doesn't mean I think they shouldn't have been charged, convicted, or punished. I have no opinion either way. I just feel sorry for them.

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zgator
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Would the outcome of this have been different if they had been drinking something like Gatorade instead of just water?
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ClaudiaTherese
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zgator, the answer is "likely, but not definitely," and the reason why takes longer to explain. I'll ty to do that over my lunch hour.
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quidscribis
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quote:
Diluted Gatorade has another name. It's called Pedialyte.
Here, its' Peditral, which I drink fairly regularly, being foreign, not able to handle the heat, sweating profusely, and drinking lots of water. Lots by normal definitions, not lots by crazy people definitions.

Get better, dags.

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Shigosei
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A child therapist suggested forcing a child to drink lots of water?!

How sad for the woman and her family. Maybe at least this will prevent other deaths from water intoxication.

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ClaudiaTherese
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Just a quick note:

Diluted Gatorade is not the same thing as Pedialyte

It is similar, but not the same, as the Pedialyte has a different balance of electrolytes and sugars than does Gatorade. It is less of an issue for bigger kids, but it can be a big issue for wee ones. Substituting Gatorade for Pedialyte (even diluted Gatorade) can put a little kid in a precarious situation.

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A Rat Named Dog
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I don't understand the idea of inventing creative, sadistic physical punishments for your children. Do people really want to model their family after the Spanish Inquisition? I mean, I understand needing to be firm with difficult children ... but stuff like forcing a kid to drink that much water ... it just seems like it steps over the line into, "How sick were you to think of that?"
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zgator
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CT, where would a 3-yr old fall on that scale? My 3-yr old had a stomach bug and was throwing up all morning recently. Our pediatrician told us that if we didn't have any Pedialyte, we could use diluted Gatorade. I have a feeling that if it wasn't safe, maybe she told us that because it was a fairly short time and I'm sure he wasn't very dehydrated, but regardless, I'd like to know for the future.
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Tatiana
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As for thinking up creative, sick punishments, I totally agree. That is a hallmark of abuse, in my experience.
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ClaudiaTherese
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quote:
Originally posted by zgator:
CT, where would a 3-yr old fall on that scale? My 3-yr old had a stomach bug and was throwing up all morning recently. Our pediatrician told us that if we didn't have any Pedialyte, we could use diluted Gatorade. I have a feeling that if it wasn't safe, maybe she told us that because it was a fairly short time and I'm sure he wasn't very dehydrated, but regardless, I'd like to know for the future.

My training was that we don't use Gatorade to rehydrate in 2 yrs old & under, and avoid it for kids under 5 who are in marked dehydration. I imagine this is a sort of gray area where you balance risks and benefits per the individual case. If it were me, I would be more cautious in an under-5-yr-old the more dehydrated the child.

That isn't much of an answer, I'm afraid. [Smile] I am most worried about the wee ones (under two, especially the infants).

----

Just out of curosity, was this a Family Medicine physician or a Pediatrician? (not implying anything -- I just like to see how the training differs, when it does)

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mr_porteiro_head
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quote:
Originally posted by Shigosei:
A child therapist suggested forcing a child to drink lots of water?!

How sad for the woman and her family. Maybe at least this will prevent other deaths from water intoxication.

I think it was actually a family therapist who specialized in extremely difficult children whom others had failed to help.

You know -- the sort of therapist who they show in episodes of Law & Order.

quote:
I mean, I understand needing to be firm with difficult children ... but stuff like forcing a kid to drink that much water ... it just seems like it steps over the line into, "How sick were you to think of that?"
I believe that it was an attempt to match the punishment to the crime, much like forcing a kid who has been caught smoking to smoke an entire pack with a bucket over their head.
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Teshi
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quote:
I believe that it was an attempt to match the punishment to the crime, much like forcing a kid who has been caught smoking to smoke an entire pack with a bucket over their head.
Please tell me this is just an example and not a real situation, because that makes me feel sick.
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zgator
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quote:
Just out of curosity, was this a Family Medicine physician or a Pediatrician? (not implying anything -- I just like to see how the training differs, when it does)
She's a pediatrician. I do think it has to do with the fact that he wasn't really dehydrated. And your answer did help if only to satisfy me that there is a gray area in things like that.
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mr_porteiro_head
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quote:
Originally posted by Teshi:
quote:
I believe that it was an attempt to match the punishment to the crime, much like forcing a kid who has been caught smoking to smoke an entire pack with a bucket over their head.
Please tell me this is just an example and not a real situation, because that makes me feel sick.
I'm not sure what you're asking. I don't know of anybody who personally did this, I have encountered the smoking example multiple times in stories. The situation with the water really did happen.
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rivka
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quote:
Originally posted by ClaudiaTherese:
Just a quick note:

Diluted Gatorade is not the same thing as Pedialyte

[Blushing]

Sorry, I should have been clearer that I was joking. Also, I have usually preferentially used Pedialyte even for older kids, because Gatorade isn't kosher (Powerade is).

Thanks for the important clarification!

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ClaudiaTherese
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quote:
Originally posted by zgator:
quote:
Just out of curosity, was this a Family Medicine physician or a Pediatrician? (not implying anything -- I just like to see how the training differs, when it does)
She's a pediatrician. I do think it has to do with the fact that he wasn't really dehydrated. And your answer did help if only to satisfy me that there is a gray area in things like that.
Yeah. If the kid isn't very dehydrated, it doesn't matter much -- after all, we don't insist kids drink Pedialyte all the time! And mildly dehydrated isn't that different than normal.

There are two main issues with electrolyte imbalances in the blood.

First, if you drink a whole lot of something very dilute very quickly (like the woman who drank so much water so fast above), then the kidneys can't process out the extra water fast enough. And so the blood itself gets very diluted.

Imagine that the kidneys have a filter, like a small membrane of thick cheesecloth. As the blood rushes past in the blood vessels, some of the water and tiny particules get squeezed though into the kidney itself. The faster the blood is flowing (heart rate) and the more pressure it is under (blood pressure), the more fluid gets squeezed through the cheesecloth (the "glomerular filtration rate," where the cheesecloth represents a bunch of filtering units known as glomeruli). However, there is a maximal rate at which stuff can get squeezed through, and at some point of water overload, the kidneys are just not going to be able to keep up.

At that point, the percentage of water in the bloodstream just keeps going up and up. The kidneys are filtering out as much of the squeezed-out fluid as fast as they can handle, and they are dumping water as fast as possible into the bladder (which just keeps stretching out bigger and bigger if the person doesn't urinate -- but the bladder can handle a lot of stress before anything would back up into the kidneys, so that's usually a one-way passage).

When the blood gets very diluted like that, the general principles of osmosis take over. All throughout the body, all the cells that see this blood flowing past will suddenly start to be a lot more concentrated in ions than the blood flowing past -- even moreso than usual. So they won't be able to help but swell up as water flows down its concentration gradient through the semi-permeable membranes into those now extra-salty cells (by comparison).

For most areas of the body, this isn't so much of a problem. Tissues can swell up and just wait until the kidneys can catch up on their filtering out of the extra water. But the brain is enclosed in the skull, which is a very hard and very inflexible case. When the brain swells past a certain point, it has only one way to go -- down. Down through the main opening for the spinal cord (the foramen magnum), where it "herniates out" and damages the main brainstem. That is where a bunch of the essential reflexes that maintain life support are, and when they blow out, so do you. [Frown]

By the way, this a main reason why medical professionals will look into the back of the eyes when they are worried about meningitis, or head trauma, or water intoxication, or any other reason that the brain might swell up (and give an altered mental status). You can see the optic nerve coming in to the retina back in there, and if the rest of the brain is swelling, so will the area around the optic nerve. It gets blurry around the edges from the puffiness.

--

A second main reason why people get into electrolyte disturbances has to do with the kidneys, but that's a different issue. Maybe later. It's very cool physiology.

---------------

Edited to add: A gentlemen who is losing a lot of fluids through his gastrointestinal tract and trying to replace them at a more normal rate is not at much risk for overloading his system with dilute water. Not only are the kidneys very good at correcting for problems if you give them half a chance, but he would likely be losing water via the GI system that never even had a chance to get absorbed.

And so this particular concern (the over-dilution leading to brainstem herniation) isn't much of an issue. However, failing to replace salts long-term can lead to other potential problems. (Foreshadowing: a sign of quality literature. [Smile] )

[ January 16, 2007, 03:47 PM: Message edited by: ClaudiaTherese ]

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