Water intoxication

Local or systemic hypersensitivity reactions may occur in some patients receiving vasopressin. Tremor, sweating, vertigo, nausea, vomiting, abdominal cramps, and water intoxication (overdosage, toxicity) may also be seen. 

D Excess Fluid Volume related to adverse reactions (water intoxication)... 

Bccesave dosage is manifested as water intoxication (fluid overload). Symptoms of water intoxication include drowsiness, listlessness confusion, and headache (which may precede convulsions and coma). If sgns of excessive dosage occur, the nurse should notify the primary health care provider before the next dose of the drug is due because a change in the dosage, the restriction of oral or IV fluids and the administration of a diuretic may be necessary. 

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

The nurse immediately reports any signs of water intoxication or fluid overload (eg, drowsiness, confusion, headache, listlessness, and wheezing, coughing, rapid breathing) to the primary health care provider. 

When oxytocin is administered IV, there is a danger of a fluid volume excess (water intoxication) because oxytocin has an antidiuretic effect. The nurse measures the fluid intake and output. In some instances, hourly measurements of the output are necessary. The nurse observes die patient for signs of fluid overload (see Chap. 58). If any of these signs or symptoms is noted, die nurse should immediately discontinue die oxytocin infusion and run die primary IV line at die rate prescribed by die primary healtii care provider until the primary health care provider examines die patient. 

Fluid and electrolyte abnormalities Hypercalcemia Volume depletion Water intoxication Adrenocortical insufficiency Drug-induced Opiates Antibiotics Antifungals Cl obstruction... 

Adverse reactions to carbamazepine include nystagmus, ataxia, diplopia, particularly if the dosage is raised too fast. Gastrointestinal problems and skin rashes are frequent It exerts an antidiuretic effect (sensitization of collecting ducts to vasopressin water intoxication). 

Drink at least eight hefty glasses of fluid (preferably water) just prior to the test. Many people start drinking water several days before the test which is useless. Water does not clean any THC metabolites out of your system because THC is not water soluble. Water only dilutes urine temporarily. Do not over do it you can get water intoxication. People can actually overdose and even die from water intoxication. It s very hard to do, and you ll vomit before anything gets serious. 

Enemas may contain water, salts, soap, mineral detergent (docusate potassium), or hypertonic (sorbitol, sodium phosphate-biphosphate) fluids. These are convenient and generally safe for short-term use. Many of these solutions irritate the mucosa and may produce excessive mucus in the stool. Excessive use of these enema products may result in water intoxication and hyponatremia. 

A possible adverse effect of desmopressin is water intoxication if too much is taken. 

Inappropriate use of oxytocin can lead to uterine rupture, anaphylactoid and other allergic reactions, and possibly maternal death. Prolonged stimulation of uterine contractions can result in the following fetal adverse reactions persistent uteroplacental insufficiency, sinus bradycardia, premature ventricular contractions, other arrhythmias, and fetal death. Prolonged use of oxytocin can lead to water intoxication secondary to the antidiuretic hormone-like effects of oxytocin. Maternal and fetal cardiovascular parameters should be monitored during oxytocin administration. 

Manley GT, Fujimura M, Ma T, Noshita N, Filiz F, Bollen AW, Chan P, Verkman AS (2000) Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke. Nat Med... 

No advantages over other tetracyclines as anti-infective higher incidence of phototoxicity active against water intoxication and SIADH... 

Water intoxication or hyponatremia, marked by headache, somnolence, confusion, decreased urination, rapid weight gain, seizures, and coma, may occur in overhy-dration. 

Enuresis 10-40 ag qhs/bid Headache nausea Hyponatremia and water intoxication at toxic doses Can be useful for acute situations (e.g., sleepaways) or as maintenance treatment DDAVP 0.1, 0.2 mg t nasal spray 10 Hg/ spray... 

Glucocorticoids maintain normal glomerular filtration rate. The adrenalectomized animal can not excrete a water load and tend to develop water intoxication and this can be treated by glucocorticoids. 

The most common dose-related adverse effects of carbamazepine are diplopia and ataxia. The diplopia often occurs first and may last less than an hour during a particular time of day. Rearrangement of the divided daily dose can often remedy this complaint. Other dose-related complaints include mild gastrointestinal upsets, unsteadiness, and, at much higher doses, drowsiness. Hyponatremia and water intoxication have occasionally occurred and may be dose-related. 

When oxytocin is used judiciously, serious toxicity is rare. The toxicity that does occur is due either to excessive stimulation of uterine contractions or to inadvertent activation of vasopressin receptors. Excessive stimulation of uterine contractions before delivery can cause fetal distress, placental abruption, or uterine rupture. These complications can be detected early by means of standard fetal monitoring equipment. High concentrations of oxytocin with activation of vasopressin receptors can cause excessive fluid retention, or water intoxication, leading to hyponatremia, heart failure, seizures, and death. Bolus injections of oxytocin can cause hypotension. To avoid hypotension, oxytocin is administered intravenously as dilute solutions at a controlled rate. 

Myxedema coma is an end state of untreated hypothyroidism. It is associated with progressive weakness, stupor, hypothermia, hypoventilation, hypoglycemia, hyponatremia, water intoxication, shock, and death. 

Water Intoxication. Ether an increased intake of water or a decreased output of water can cause an excess of body water. Because healthy kidneys have outstanding ability to increase water excretion, a condition of water intoxication usually occurs because of a disability to excrete water (hyponatremia). Frequently impairment may not be the result of disease or damage to the kidneys per se, but rather due to faulty processing of stimuli by the kidneys. Excessive renal reabsorption of water can result from the action of antidiuretic hormone (ADH) or by the excessive reabsorption of sodium in the proximal tubules. Under such conditions, the excretion of water and sodium will be low. Retention of salt and water causes an expansion of the ECF, usually resulting in edema and effusions. 

A potential risk of desmopressin is of water intoxication with resultant hyponatremia (48), and rapid falls in serum sodium concentration can result in seizures. The risk is increased in infants and patients receiving hypotonic intravenous fluids, and such patients need to be carefully monitored. 

Odeh M, Oliven A. Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis. J Clin Pharmacol 2001 41(5) 582-4. 

Acute water intoxication has produced maternal cerebral edema and convulsions in under 50 reported cases, both with intravenous and intranasal administration (10). The risk is higher in women given high doses of the drug in combination with salt-poor intravenous fluids. In rare cases this has been fatal. 

Even low-dose intravenous cyclophosphamide can cause a syndrome that resembles inappropriate secretion of antidiuretic hormone, with severe hyponatremia and symptoms of water intoxication (SEDA-19, 347 SEDA-21, 386). A direct effect on the renal tubules is likely, but no other nephrotoxic effects have been documented. 

When oxytocin is used properly, serious toxicity is rare. Among the reported adverse reactions are maternal deaths due to hypertensive episodes, uterine rupture, water intoxication, and fetal deaths. Afibrinogenemia has also been reported. 

Vasopressin [vay soe PRESS in] (antidiuretic hormone, ADH), is structurally related to oxytocin (Figure 25.5). The chemically-synthesized nonapeptide has replaced that extracted from animal posterior pituitaries. Vasopressin has both antidiuretic and vasopressor effects. In the kidney it binds to the V2 receptor to increase water permeability and resorption in the collecting tubules. Thus the major use of vasopressin is to treat diabetes insipidus. It also finds use in controlling bleeding due to esophageal varices or colonic diverticula. Other effects of vasopressin are mediated by the Vi receptor, found in vascular smooth muscle, liver and other tissues. As might be expected the major toxicity is water intoxication and hyponatremia. Headache, bronchoconstriction and tremor also can occur. Caution must be used in treating patients with coronary artery disease, epilepsy and asthma. 

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