Respectful Insolence

A truly pointless way to die

After competing in a water-drinking contest to win a Wii for her children, a young mother died of water intoxication:

SACRAMENTO, California (AP) — A woman who competed in a radio station’s contest to see how much water she could drink without going to the bathroom died of water intoxication, the coroner’s office said Saturday.

Jennifer Strange, 28, was found dead Friday in her suburban Rancho Cordova home hours after taking part in the “Hold Your Wee for a Wii” contest in which KDND 107.9 promised a Nintendo Wii video game system for the winner.

“She said to one of our supervisors that she was on her way home and her head was hurting her real bad,” said Laura Rios, one of Strange’s co-workers at Radiological Associates of Sacramento. “She was crying, and that was the last that anyone had heard from her.”

It was not immediately known how much water Strange consumed.

A preliminary investigation found evidence “consistent with a water intoxication death,” said assistant Coroner Ed Smith.

John Geary, vice president and marketing manager for Entercom Sacramento, the station’s owner, said station personnel were stunned when they heard of Strange’s death.

“We are awaiting information that will help explain how this tragic event occurred,” he said.

Initially, contestants were handed 8-ounce bottles of water to drink every 15 minutes.

“They were small little half-pint bottles, so we thought it was going to be easy,” said fellow contestant James Ybarra of Woodland. “They told us if you don’t feel like you can do this, don’t put your health at risk.”

This is just a reminder. Your kidneys are wonderful organs. In a young, healthy person, they are amazingly efficient at getting rid of excess free water (free water is water without electrolytes) and regulating the electrolyte balance in the blood. However, as amazing as your kidneys are at doing this, they do have their limits. Healthy kidneys can only excrete a maximum of around 1 liter of free water (or slightly more) per hour. Age and disease will decrease this capability. This particular contest had people drinking approximately 250 ml of water every 15 minutes, or 1 L per hour, which is at the capability of most people’s kidneys to eliminate. Now, drinking 1 L of water in an hour won’t hurt most people (lots of people, including me, do it), but drinking 1 L per hour for multiple hours might, and the story above says that after one hour contestants were given even bigger bottles to drink.

Criminal stupidity!

What probably happened is that this woman developed a dilutional hyponatremia (low sodium concentration in the blood), because she was drinking water without any electrolytes in it. The normal level of sodium in the blood is 135-145 mmEq/L. Although below a sodium of 120 mEq/L, hyponatremia is considered life-threatening, the body can adjust to fairly impressive levels of hyponatremia (in the 120′s or even lower) when the hyponatremia develops slowly. It can’t do so well when hyponatremia develops rapidly, as it almost certainly did in this case. Because cell membranes are freely permeable to water but impermeable to electrolytes like sodium ion except by special ion transport channels, what happens in these cases is that water flows from areas of low electrolyte concentration (the serum) to areas of high electrolyte concentration (inside the cells) to equalize the electrolyte concentrations. (This is called an osmotic gradient.) This results in swelling of the cell, even to the point of rupturing the cell membranes. In the brain, this causes cerebral edema, with catastrophic and often fatal results. In addition, the kidney, to get rid of that free water, is physiologically obliged to excrete small amounts of other electrolytes, including magnesium, and low magnesium can lead to cardiac arrest. It is not revealed how large a woman Strange was, but I’d be willing to hazard a guess that she was probably fairly small, so that it took less water than it would in a muscular young man to result in such an outcome.

One can only hope that such a criminal level of ignorance and negligence results in appropriate penalties. Allthough I do not discount individual responsibility, most people are ignorant of how little it can take to cause water intoxication. It is not stated whether (1) contestants were warned that they could die from drinking too much water too fast or (2) qualified medical personnel were present to monitor the contest. In addition, it doesn’t say whether the radio station had vetted its idea with a physician. I doubt that it did, because any competent physician would have told the organizers that this contest was a very bad idea and dangerous, to boot. Given this, the radio station showed an uttterly reckless disregard for the safety of the contestants.

(Hat tip to GruntDoc, Pharyngula, and Retrospectacle, plus readers who sent me links to this story this afternoon.)

Comments

  1. #1 doctorgoo
    January 14, 2007

    I agree with you that your average person would have no idea how dangerous this is. To most people, this would just be a harmless stunt to try to get a free game. But this doesn’t excuse the radio station. If they didn’t take the proper precautions to keep things safe, then they’re most likely in deep doo-doo.

    Here’s another news article that reports more from the other contestant, Ybarra, which indicates that they weren’t properly informed of the dangers.
    http://www.news10.net/storyfull2.aspx?storyid=23350

  2. #2 Mithrandir
    January 14, 2007

    I’d bet cash money that the radio station folks hadn’t the faintest idea it would be dangerous either. Not that this excuses them, I’m just saying.

  3. #3 Infophile
    January 14, 2007

    According to the article Doctorgoo linked, the contestants had to sign liability waivers. Now, no liability waiver is going to protect them from causing the death of a contestant, nor is a vague warning that they shouldn’t do it if it will put their health at risk. Instead, I think this makes them look even worse. They must have known there was some danger, but they didn’t cancel the contest or even have a medical official on hand. Now, that’s negligence.

  4. #4 Scott Simmons
    January 14, 2007

    I think you made a conversion error, Orac (as hard as that is to imagine a superintelligent computer doing). You said:
    “This particular contest had people drinking approximately 500 ml of water every 15 minutes, or 2 L per hour, which is beyond the capability of most people’s kidneys to eliminate.”
    But the article says that:
    “Initially, contestants were handed 8-ounce bottles of water to drink every 15 minutes.”
    8 ounces is just under 250 ml, so the contestants were (at the start, at least) drinking ~1 liter per hour. If, as the contestant that dropped out said, they started using bigger bottles later, that may have pushed it over the limit. And the ‘no urinating allowed’ factor is relevant–once the bladder was full, it may not matter how much water the kidneys could process, as they’d have nowhere to put it …

  5. #5 Orac
    January 14, 2007

    Actually, you’re right about the conversion. Mea culpa. That’s what I get for typing too fast.

    However, you’re wrong about the not being allowed to urinate. Unless she had incompetent ureteral valves, so that the back pressure caused serious reflux back into the kidney over a prolonged period of time, the fact that she wasn’t allowed to urinate is unlikely to have had anything to do with her death. Besides, presumably once she dropped out of the contest she did urinate before going home; I doubt she would have gotten in a car still in extremis, so to speak.

  6. #6 decrepitoldfool
    January 14, 2007

    This is why I told my kids that no matter what I die of, no matter how stupid or humiliating, it should be plainly stated in my obituary in the paper. The information could alert someone else to the danger. Or (more likely) people could at least say, “he even managed to die in a boring way.”

  7. #7 Felix Kasza
    January 15, 2007

    Isn’t water on the list of GRAS substances? If so, why would it be the radio station’s responsibility?

    Salt carried no warning labels either, last time I checked — and the LD50 is far lower than for H2O.

    Anyway, just think of it as evolution in action — weeding out people who have a greater desire for an imbecilic video game console than they have common sense.

    Cheers,
    Felix.

  8. #8 epador
    January 15, 2007

    California.

    Need we say or read more?

  9. #9 valhar2000
    January 15, 2007

    Given this, the radio station showed an uttterly reckless disregard for the safety of the contestants.

    Did they really? To be honest, this sounds like something the vast majority fo people simply don’t know. The people from the Radio Station probably just thought that it would be a bit of fun and that they would have to clean the lavatories that night, but nothing more.

    Is there evidence that this was more than a mistake?

  10. #10 Paul
    January 15, 2007

    I remember back in the mid to late 1990′s there was an effort made in the UK to raise awareness about the potential dangers of drinking too much water. This was prompted by the deaths of several clubbers who had taken ectasy and then drunk too much water in an attempt to avoid dhydration. Previously there had been campaigns to make sure that clubbers did not become dehydrated. As far as I’m aware most deaths directly associated with ectasy (excluding RTAs and STDs) have been due to either dehydration or water intoxication.

  11. #11 a lurker
    January 15, 2007

    regarding “Free water” (water free of electolytes): Could a sports drink balanced with electrolytes and minerals make a contest like this safe?
    If no existing drink does, would it at least be possible to concoct such a beverage?

  12. #12 Nelson
    January 15, 2007

    The radio station should be prosecuted for criminal negligence. Don’t run a contest promoting people to do something (particularly putting things into their bodies) without checking first from an expert (a doctor) to find out if it is dangerous. The thing that sticks out in this situation is they were HANDING out the quantity of water to be drank therefore implying it was safe to do so.

  13. #13 neil
    January 15, 2007

    “Anyway, just think of it as evolution in action — weeding out people who have a greater desire for an imbecilic video game console than they have common sense.”
    Felix, this comment is exactly the sort of thing that the anti-evolution and anti-science crowd love to hear from us.
    If you really believe that evolution in action BS, then you might as well say that doctors should never treat a patient for anything…. such an ignorant comment.
    This woman was not really at fault here, probably had plenty of common sense, there is no way a lay person could really be expected to know the risks here. She was only 28, young and invincible in her own mind. This should of run by a doctor before hand, it certainly was run by a lawyer (note the waiver). Perhaps its an american thing, people worry about being sued before worrying about harming someone. They really seem culpable here, when she felt ill after the contest they could at the very least at that point got her a doctor.

  14. #14 Invigilator
    January 15, 2007

    Hey, I’m just a normal layperson (OK, maybe I flatter myself that I know a lot of stuff, but certainly don’t put physiology anywhere near the top of the list of stuff I think I know), and I thought this was a criminally stupid contest as soon as I saw the headline this morning. Surely the knowledge that water can be poisonous goes back at least to Paracelsus, or, less pleasantly, to the Inquisition.

    Idiots. Criminally liable idiots. Certainly civilly liable.

  15. #15 boojieboy
    January 15, 2007

    Hyponatremia or hypokalemia? I thought the mechanism of death in cases of water poisoning was the latter, with out of whack potassium levels causing cardiac arrest…

    I know, I know: I could just look it up on wikipedia. Matter of fact, I’m off…

  16. #16 stgben
    January 15, 2007

    epador said:
    “California
    Need we say or read more?”

    Yes please do. If you’re in implying all Californians are like this, I’m very sorry for you.

  17. #17 Dean
    January 15, 2007

    Is it just me or does the radio station’s tagline seem…appropriate?

    KDND 107.9 – The End.

  18. #18 RJK
    January 15, 2007

    epador doesn’t mind eating fresh California-grown vegetables while trapped in his home by snow in the Winter, watching TV or movies predominantly made in California, paying lower Federal taxes because Californians pay a larger percentage of them than other states, that three out of four new businesses in the USA start in California or it’s robust and diversified economy benefits everyone nationwide. Or perhaps it’s just envy…

  19. #19 Felix Kasza
    January 16, 2007

    Hi Neil,

    regarding “think of it as evolution in action” — that was actually a quote (and screamingly funny tagline) from Niven/Pournelle’s _Oath Of Fealty_.

    Nice strawman you knocked down; I ridiculed idiots who inflict harm on themselves for a video game; you claim that, according to me, doctors should stop treating any and all conditions. Perhaps a subtler approach next time?

    Cheers,
    Felix.

  20. #20 Porlock Junior
    January 16, 2007

    Hate to spoil the level of civility that this thread has attained, but since some person with medical knowledge might read this, I’ve got a question.

    Infants suffering from gastrointestinal unpleasantness, being much in danger from dehydration, and electrolyte loss I suppose, are supposed be given great amounts of Pedialyte(tm) or equivalent. I hear that it has a formula that provides the right electrolytes with a magical amount of sugar that enhances absorption. Or something. Related to stuff that keeps people with cholera alive long enough to recover.

    So the question is, when an adult has some nice thing that causes everything consumed to be ejected promptly from one end of the tract or the other or both, wouldn’t it be a good idea to be chugging this stuff? And if so, why isn’t it ever recommended?

  21. #21 Andrew Dodds
    January 16, 2007

    Porlock –

    Having once being a sufferer of POOYAS (Pissing Out Of Your Arse Syndrome, a.k.a. Salmonella), I can say that the advice we were given – we were on an orchestral tour to spain when half the orchestra went down with it – was to drink flat coke and not eat anything. I suppose that this was where the sugar came from.

    I’m not sure if it helped, it wasn’t the most pleasant experience.. but if you ever fancy doing something extremely inadvisable and dangerous to lose weight, Salmonella certainly works.

  22. #22 RJ
    January 16, 2007

    This all reminds me of a drinking game that was popular when I was at med school. The game was known as “Centurion” and allegedly originated from Canada.

    The rules were simple:

    i. participants drank a 60ml shot of (full-strength) beer every 60 seconds, for 100 consecutive minutes – i.e. 6L of beer in just over an hour and a half.

    ii. vomiting = disqualification.

    I hazily remember one colleague who continued on alone to about 147 until he passed out under the keg.

    The hardest job was being the timekeeper, as you were in charge of calling the minutely shots, and making sure that no-one was slacking off.

  23. #23 bwv
    January 16, 2007

    porlock:

    Gatorade has the same stuff that Pedialyte does.

  24. #24 jimsg
    January 16, 2007

    Some marathon runners have died of hyponatremia, and so runners have had a bunch of recent education about all this. The typical victim has small mass (mostly women), takes a long time to finish the race (not a problem for the elite runners), sweats a lot on a hot day (losing more electrolytes) and drinks only water, and a lot of it.

    The basic advice given to us slow marathon runners is to make sure to drink some of the sports drink that all long races provide – getting some electrolytes keeps everything within reasonable bounds.

  25. #25 Julie Stahlhut
    January 16, 2007

    I’ve read speculation that more distance runners have died or become seriously ill from water intoxication than from dehydration. Being neither a health professional nor a human physiologist, I’m understandably curious. What’s the call on this from the medical folks?

  26. #26 Melissa G
    January 16, 2007

    It’s not just California radio stations that do idiotic promotions:

    http://news.bbc.co.uk/2/hi/uk_news/england/2691229.stm

    (The story of a UK radio station that had contest participants sitting on blocks of dry ice to win concert tickets.)

  27. #27 Ahistoricality
    January 16, 2007

    As Tom Paxton says (after making people join in singing a silly song, nothing dangerous, except perhaps to your self-esteem), “It’s amazing what people will do if you just ask them to.”

  28. #28 Melissa G
    January 16, 2007

    As Tom Paxton says (after making people join in singing a silly song, nothing dangerous, except perhaps to your self-esteem), “It’s amazing what people will do if you just ask them to.”

    A Feynman anecdote leaps to mind…

  29. #29 kemibe
    January 17, 2007

    Julie and Jim,

    I’ve discussed hyponatremia and deydration specifically as they pertain to distance runners here and here (a two-part “series”).

  30. #30 nevins
    January 18, 2007

    The public can expect differing levels of responsibility for the safety of contests depending on who’s running it. A hospital doing this style contest would certainly have tapped its specialists for council on proper safe practices and modified it accordingly. Likewise we would expect a higher standard from the hospital.
    Now the actual contest was run by the learned professional known as Disk Jockeys. Their credentials include the ability to produce inane chatter, provide rude remarks to callers, and might have held the position in high school of ‘class clown’. High school diploma not required for position of DJ. These are the folks, joe average American, who staged this contest. Their level of culpability should be comensurately lower, and no greater than joe average American contestant. Everyone was guilty of stupid sophomoric behavior, none more than the other, so call it a wash. Leson learned until the next crop of juvenile young adults takes their place.

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