Water Intoxication Resulting in Ventricular Arrythmias

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 the ingestion of excessive water is an infrequent method for attempting suicide. In this case report we present a 51-year-old woman with ventricular fibrillation due to electrolyte imbalance caused by excessive water ingestion during a suicide attempt. The patient was admitted to our emergency clinic with altered consciousness and agitation. She was hypertensive and neurological examination revealed no lateralizing signs. Ventricular arrhythmias, cardiopulmonary arrest and tonic-clonic seizure were observed during hospitalization. Blood chemistry showed hyponatremia and hypokalemia relevant to the 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. The patient was referred for psychiatric evaluation and was discharged with antidepressive medication. Although water intoxication is well described in psychiatric disorders such as schizophrenia, it has not been previously reported in depressive patients with suicidal thought. Awareness of the clinical presentation of this rare situation may prevent potentially fatal complications.