By Emily Dinning
A 30-year-old British athlete died in July after the finish of the 2015 Ironman European Championships; a 17-year-old high school football player died a few days after a football practice on an incredibly hot day in 2014 and a 55-year-old woman had a seizure during treatment for depression. The common denominator: swelling in the brain due to water intoxication—and a UVA doctor wants to alert people about this rare but deadly condition.
Also known as overhydration—official name: hyponatremia—it’s prompted international guidelines in the Clinical Journal of Sports Medicine, and UVA kidney specialist Mitchell Rosner led the committee that warns athletes of the dangers of drinking too much water.
“When I was a med student, I took care of a young girl who was a marathon runner, a young lady who devoted a lot of time to training,” he says. “At the 20th mile of her race, she began to get sick. At the finish line she had a seizure and collapsed. When she was brought to the ER, I was caring for her. She had severe hyponatremia and died, so I have devoted a lot of time and energy to creating preventative strategies to the condition.”
There have been 17 documented deaths from hyponatremia, according to Rosner, including the notorious 2007 death of a California woman who won a radio station’s water-drinking contest.
The 55-year-old woman’s seizure was induced by excessive water intake while being treated for depression, according to a case study. The woman admitted to drinking 5-10 liters of water each day while she was hospitalized, more than double the Institute of Medicine’s recommendation of 2.2 liters a day for a woman and 3 liters each day for men.
“When the sodium level in your blood falls too much, there will be a swelling of the cells in your brain,” says Rosner. “In mild cases, the symptoms can be headaches or nausea but if the swelling gets really bad, it could lead to seizures and death.”
Popular belief holds that consumption of water must come before feelings of thirst. That can make too dilute an amount of salt in the blood of inexperienced athletes. Now the advice is for people to drink when thirsty, says Rosner.
For professional athletes, that advice is a little different, because they may already be dehydrated when they notice they’re thirsty. “Once somebody realizes that they’re thirsty, they might fall behind and are already behind the dehydration gradient,” says Randy Bird, UVA’s sports nutritionist. “You need a strategy to account for hydration and electrolytes in that case.” That strategy includes weighing before and after exercising, and then consuming that exact difference of water, he says. Current literature on the condition is sparse and conflicting, explaining why the symptoms of hyponatremia are easily mistaken for dehydration.
That’s what happened with Georgia teen Zyrees Oliver, who died early August 2014 after being on life support for five days. According to USA Today, Oliver was not only a phenomenal athlete but also a great student. He and his family had mistaken his symptoms of overhydration for symptoms of dehydration, and he drank himself to death by consuming two gallons of water and then two more gallons of Gatorade.