Dihydrogen monoxide kills

This is really sad stuff. What a stupid stupid contest.

This happens periodically -- people assume that water is safe, since it's not alcohol, and not caffeine. But something that puts the body's electrolytes level so out of whack can be deadly. Jane Brody's column in the New York Times covered the issue of hydration a few months ago. In the previous year, not a person had died from dehydration in any formal running event, but several had died after marathons from over-hydration.

It's the same effect one gets from freshwater drowning. Our bodies try to balance out the electrolytes in all the fluid. The sudden rush of salts from our body to the other liquid, or the dilution of the salts, results in circulatory collapse and heart failure.

The headache was a big clue. A physician should have been on hand, and administration of electrolytes might have made it just a minor issue.

"Everything in moderation" takes on a sudden, life-saving meaning.

There is a larger issue here, of risk-taking, risk assessment, and knowledge of what can be fatal. There is, for example, the conundrum of what we do about selenium. In trace amounts, selenium is an essential nutrient. In those same amounts, however, it is carcinogenic. The Delaney Clause in the Safe Food and Drug Act prevents using any known carcinogen as an additive to foods. Selenium is also present in potatoes, but food itself is not considered an additive.

Kids sometimes develop an over-affection for a food. There are stories in the literature of kids turning rather orange after a couple of months of a diet of almost exclusively carrots, for example. In one food safety meeting years ago a fellow commented that was no problem, since it was impossible to overdose on vitamin A. Of course, the stuff that makes the kids orange isn't vitamin A, its carotene. It not only is possible to overdose on vitamin A, that's probably what killed some of the Antarctic explorers who butchered their dogs and ate the livers, not realizing that by doing so they were poisoning themselves. (Inuits and other Arctic natives know not to eat the liver of a polar bear for the same reasons -- vitamin A concentrates in livers.)

A few times a year one may read of some upstanding citizen being arrested for public drunkenness and dying in jail. Diabetic complications can closely resemble drunkenness, down to the smell of the breath to the uninformed. Untreated, the diabetic conditions can lead to death. How many cases go unreported?

Science is fascinating, and ignorance can kill. I hope this story hits the front pages, but I'll bet it doesn't.

eating and drinking contests are stupid. I've always thought there could be some serious risks from them.

The curiosity is killing me though... did she win/would she have won the wii?

so ed, are you saying that when one drowns one doesn't die because of lack of oxygen but because freshwater wrecks havoc with your electrolyte concentrations?

I learned the hard way about over-hydration, though it was because I went in the other direction, so-to-speak. While I was going through Army Basic Training, I came down with pneumonia and my appetite all but disappeared (more than a spoonful of cereal made me feel like retching). My electrolytes were therefore very low. Despite repeated orders from the doctors, the drill sergeants kept trying to train me--including the requisite screaming for being "weak," though I'd have liked to see a single one of them try to run a mile with their lungs filled with fluid....

Because the DS's were obviously very poorly trained when it came to health (is my contempt for Army training a little too obvious? ;-) ) and because their response to anything was to "drink water," when I showed what I now know are the obvious signs of over-hydration/hyponatremia (the two different approaches to the same result), their belief was that I was just dehydrated and... needed more water.

It all came to a head when I collapsed in the hole where you stand to do M-16 training. The response was of course to drink more water. Afterwards we went back, we stopped at the mess hall, but by this time I was half-delirious and my appetite was even less than usual. I tried to eat, but every bit was pure nausea. I had to wait for the whole platoon to get back to the barracks, where I was given a saline IV because I was "dehydrated."

Now, this is where it gets interesting: immediately upon getting this IV drip, my bladder felt like it was going to explode--a sure sign that my body just wasn't absorbing anything. I told one of the drill sergeants (a total Bill Duke wannabe) that I really had to go to the bathroom, and he fucking squeezed the rest of the saline IV into me (shame for it to go to waste, after all...), before letting me go.

I finally was able to go up to the bathroom, where I basically re-enacted the scene from Austin Powers by pissing out what must've been the entire saline bag over a period of a few minutes.

I then stumbled to my bed, fell asleep, had a few weird visions (had the whole "white light" thing, yet I was never pronounced dead; further proof the NDEs are just your brain going haywire), and woke up strapped to a hospital bed. I had been strapped to it for my own safety because I'd been convulsing. I had apparently also been in a coma for three hours.

After a week in the hospital, I was released, but despite the doctor's orders for me to be sent home to recuperate immediately, I was kept at the training battery for another three weeks, before finally being sent home. It wasn't until over two months later that the muscles around my ribs which had been torn from the unrelenting coughing finally healed.

Needless to say, I have absolutely no respect for Army drill sergeants.

Hey PZ, too bad it wasn't energized water with a bond angle of 10 degrees greater, right? Had it been that, I'm sure she'd be living to a couple hundred years old.

Right -- drowning is not suffocating. Deprivation of oxygen can cause difficulties on revival, but drowning death is generally caused by circulatory failure -- heart attack. In freshwater drowning, your body tries to push electrolytes from your body fluids to the new, non-saline fluids in your stomach and lungs (note that the water doesn't have to be in your lungs to cause difficulty); in saltwater drowning, the difficulty is caused by trying to deal with the extra salinity in the fluid in the stomach and lungs.

In advanced first aid courses, responders get the warning to watch people who are rescued. Pulled from the water, revived with CPR, or simply reviving on their own, they may claim to feel fine, only to die later from circulatory collapse. The body chemistry thing is a big deal.

Evolutionary vestiges, you know. It's another example of where ignorance can be compounded and lead to disaster.

And yet, people think I'm nuts when I say that there was an experiment done to find the LD50 number of water (which is around 2 gallons).

I can't believe the radio station did that. Last time I listen to 107.9, for one. For another...hmm. Maybe I'll go down there and say something. Or leave a few bottles of water holding in place a sheet of paper with some red handprints on the doorstep tomorrow night. Just to get the point across...

So very tragic. Hopefully the word will get out to the public about the danger of these types of events.

So, is it hydrogen hydroxide, or Dihydrogen monoxide ? I was always taught water was a hydroxide class, but I don't know what's the standard this year.

Ed:
I don't want to start a flame war, and I'll admit I'm not a doctor (although I am a chemist), but I'm still skeptical. It seems to me that even if the official cause of death in drowning is cardiac arrest, it's probably still cardiac arrest brought on by oxygen deprivation as opposed to electrolyte imbalance, wouldn't you think? Otherwise it should take appreciably longer to drown in brackish water with an ionic strength closer to physiological.

Ed:

I'm currently with Ian on this one. The relevant wikipedia page makes some mention of electrolyte imbalance but mostly it describes drowning as "the filling of the lungs by a liquid causing the interruption of the body's exchange of oxygen from the air leading to asphyxia." There is only one small section on cardiac arrest from electrolyte imbalance. Mostly it's just lack of oxygen.

I realise that WP is not necessarily the best source of information. Can you provide better sources?

Here is a stupid question, since her death was caused by an electrolyte imbalance, if she had been chugging Gatorade, would she have been fine?

DFX--I don't think that is a stupid question. I was about to ask it myself.

Although I was unaware of the dangers of drinking too much water (I tend towards dehydration myself if I'm not careful), I would have thought they would have also been medically aware of the dangers of "holding it." Unless that's a myth, although my Mom always told me it isn't good for you to deny your bladder relief. In fact, I always think of Tycho Brahe when I hold it for too long...

Drowning is really pretty much synonymous with asphyxiation. Water is an asphyxiant, in that it displaces breathable air. As to ithika's find on Wiki, that's generally right, but there is such a thing as a "dry drowning", which is where the epiglottis closes before any water can get into the lungs. Same end result (death, usually), but the lungs are "dry". While I'm sure that electrolyte balance shifts with relatively hypotonic water in the lungs, I'd bet dollars to donuts that hypoxia is of greater concern, and then, for saved drowning victims, bacterial pneumonia.

And Nick, I'm pretty sure you could look at it either way. Organic chemists would probably prefer the former, I'd say.

We'll just have to drown some people in 0.9% normal saline and see.

Oh, and one more thing. Wouldn't you think that during the conception, planning, organizing, etc., etc., of this event, someone somewhere along the way might have said to him/herself, "perhaps it would be good to consult a medical professional on this one"?

It kills me that the news report mentions that the death was a surprise to the event organizers. Piss poor planning...

John, I anticipate difficulty filling a clinical trial for this one.

"We'll just have to drown some people in 0.9% normal saline and see."

I volunteer my roommates! and their friends! I'll even carry the experiment myself, just give me the solution or tell me how to make it.

*mumble mumble* darn roommates.

Sure, responders might be trained to watch for electrolyte imbalance. Unlikely, since that's more of an EMS job, but it's possible.

But one thing I do know fer darn sure that the first thing they do for drowning is make sure the victim is breathing. Page One of the handbook, at least here. It's a much, much bigger concern than electrolytes.

I see a lot of people heaping criticism on the radio station for this. Granted, it would be wise to have medical staff on hand for any kind of endurance consumption competition, since some people just don't know when to quit. But as Andrew learned the hard way, the conventional wisdom is that it's pretty much impossible to get too much water.

It wouldn't have occurred to me that electrolyte levels could drop dangerously because of such a stunt, although it seems pretty obvious in retrospect. In a world where small Japanese men win worldwide hotdog-gorging contests and overconsumption of alcohol is considered a rite of passage, it would seem that a water-drinking contest would be next to harmless, even if participants are precluded from draining the lizard.

So while the radio station made a terrible mistake, I don't think the charge of incompetence should be leveled against them.

This is heart breaking. Children are left motherless no matter how banal the mothers death was. I hope the kids have support.

Causes of death are listed by the event that leads to death, at least here in Canada. This is done to codify mortality, as the natural endpoint of life culminates in cardiac arrest, with the exception of brain death. (Hence all those good looking coma victims on prime time.)

This woman's cause of death would be appropriately listed as acute water intoxication. She likely died from cerebral edema secondary to acute hyponatremia. It sounds like she coned and died, though she may have seized and aspirated and then drowned in her own vomit. The risks of water intoxication are well known. I hope this radio station has deep pockets because after the criminal trial there will be one hell of a civil suite, and deservedly so.

Regards.

There is a huge and important difference between:
IGNORANT - which is cureable - and this woman was undoubtedly ignorant of the water intoxication problem.
and
STUPID - which is knowing about something, and carrying on anyway.

The radio station should have known, and checked.
I would have thought a criminal prosecution against the radio station would stand a good chance of succeding.

Consumption contests are often dangerous, but you don't hear about it much. A woman died here in my hometown last fall during the annual fall fair, while participating in a contest to see how many marshmallows one could stuff in one's mouth. She aspirated a marshmallow, it expanded and wedged in her airway, and no one was able to extract it before she asphyxiated.

I was stunned at the stupidity of the radio station when I heard about this. You can bet they are going to be facing a huge lawsuit.

So while the radio station made a terrible mistake, I don't think the charge of incompetence should be leveled against them.

I disagree. I am no doctor, no scientist, my formal education ended at eighth grade, but I have heard plenty of stories of water intoxication in the press. And there's always a story in the paper every couple of years of some parent killing their kid my making them drink too much water.

The contest was flat-out stupid and dangerously so.

People have died from too much water, both in extreme endurance races and in fraternity hazing incidents, and these incidents have been well-publicized:
http://www.npr.org/templates/story/story.php?storyId=5012154

There is absolutely no excuse for the radio station to have run this promotion. *insert snarky remark about Sacramento and the people who live there*

I predict they will settle out of court for an undisclosed amount. The huge company that owns the station will absorb the cost, and not even a single person will be fired or otherwise held accountable.

As much as I'd like to see a criminal prosecution in this case, I don't have much faith in our local DA to do the right thing. Whenever law enforcement or a monied interest is involved in committing a crime, the answer always seems to be the same, "not enough evidence to prosecute". Criminal charges might be filed, but I'm not holding my breath.

Don,

They weren't incompetent. They were negligent. I personally believe the trial will come down to the following:
Was it reasonable to expect that the radio station have medical personnel on hand?
(absolutely - there is no way the radio station could successfully argue their way out of this one, with or without a waiver - it is certainly REASONABLE to expect that of the radio station).
Could having such have changed the outcome?
(certainly a possibility. Basically, could this woman's death be attributed - either directly or indirectly - to the absence of medical personnel? Absolutely, no question about it. That doesn't necessarily guarantee it, but it COULD have kept her alive).
Did the radio station neglect to fulfill this reasonable expectation?
(certainly seems like it, though I only have the news reports to go by.)

Prosecution has it in the bag, I think.

In re drowning, most people that fall overboard, especially at sea, don't drown. Hypothermia gets them first.

Consumption contests are utterly stupid. The moronic radio station put more thought into the name of the contest ("Hold your wee for a Wii") than the contestants.

DFX,

I'm not a physiologist, but I think it would be much more difficult, if not impossible, to water intoxicate with Gatorade which contains electrolytes as well as quite a lot of sugars.

The sugars slow transit into the gut. The reason for the sugars is to help more electrolytes be absorbed. It would also be much more uncomfortable to drink very large quantities rapidly as one would feel full. Water, OTOH, is absorbed directly across the stomach wall as well as in the gut thereby diluting the serum electrolytes much more efficiently.

I know that when treating cholera, which often kills by dehydration alone, oral rehydration solutions are consumed by the quart. However, these are carefully formulated to contain both sodium and potassium to avoid just the kind of electrolyte imbalance that killed this unfortunate woman.

This was a real tragedy. It's too sad someone didn't give the contest more thought.

If you're curious about the physical aspects of water inhalation, see the Wikipedia article on drowning.

Generally radio stations have corporate overseers who have insurance policies and insurance advisors and lawyers who check out all contests. Something in that process clearly broke down here. I hope the station has a big company behind it with very deep pockets. I also hope they won't contest the wrongful death suit, even if the woman signed a release. Radio stations have a duty not to run dangerous contests, and to disclose dangers that may be involved.

For that matter, consider the contests to "keep a hand on" a vehicle for the longest period of time. Most of them allow hourly bathroom breaks, but renal failure or circulatory problems certainly could kill in such a contest.

And don't get me started on the slapping stuff on NYC radio stations.

I would guess that most members of the public don't know that you can die from drinking too much water; but the company putting on the contest is responsible for researching the risks and devising ways to avoid them. The contestants could assume that the company running it wouldn't put them into danger. They were wrong; and the company is negligent.

Drinking something like Gatorade(TM) would, IMHO, be much safer because it would supply the isotonic solution of electrolytes needed by the body.

*insert snarky remark about Sacramento and the people who live there*

Bite me.

Water intoxication was, if I recall correctly, an old Chinese execution method. I remember going "WTF?" when I first heard about it and then going "of course!" once I got the explaination.

- JS

While the Radio station really should have done check, it's a case of something most people don't know becoming deadly. To the Radio station it seemed perfect. I mean isn't water perfectly safe, and arn't you supposed to drink a lot? People don't realize that something you need to live will kill you in high enough concentraions. To quote The Lake Texarkana Gamera "Oxegen is so overrated. People forget that in high enough concentrations it's nothing more than deadly shit."
When I was DJ'ing at my colleges radio station we never did anything like a consumption contests. It was always caller number, or trivia. I suppose you could have eaten yourself to death if you won the pizzaria gift card, but that's it.

Andrew learned the hard way, the conventional wisdom is that it's pretty much impossible to get too much water.

oh, I think case history proves you wrong on this one, hands down.

ever heard the expression: "Ignorance of the law is no excuse"?

I would expect that if the radio station actually even has liability insurance (woe to them if they don't), very likely terms are explicitly stated in their liability policy requiring them to do standard checks before proceeding with a "contest" of this nature.

Not only didn't they bother to check, they seem to have forgotten that about a year ealier, in the same area, a local sports hero died of the exact same thing.

OH YES, you betchya that radio station is liable. Big time. Even if the participants signed waivers, in California, such waivers hold no legal weight (you cannont legally waive your rights in such a manner in this state). The real question is, could Nintendo also be found liable for sponsoring the contest?

I could see legit arguments for including them in a wrongful death suit.

But I have little doubt the stations will be found liable in civil court, and likely the district attorney is considering criminal charges based on negligence.

this is as clear a case of negligence/wrongful death I've seen pop up in the media in a while.

don't get me wrong; I have nothing against this particular radio station, nor any radio station that wants to run contests, but this is not medical information that is hard to locate, by any means, and not having a medical professional on hand would violate any liability policy i can think of. Again, if they didn't even HAVE a liability policy to cover this, this station is in deep trouble.

. To quote The Lake Texarkana Gamera "Oxegen is so overrated. People forget that in high enough concentrations it's nothing more than deadly shit."

exactly, you actually counter your own point by quoting this example.

people are poisoned by over-exposure to oxygen on a regular basis.

this again, is an easy thing to find out, and is known by even the most basically trained of professionals that have to deal with oxygen in the field (like firemen).

"common wisdom" is not a legal argument one can make here.

exactly, you actually counter your own point by quoting this example.

Um, I think you misunderstood. The two of you are actually violently in agreement.

Of course, the comment you're referring to could have been punctuated and formatted a little differently, which might have clarified the point a bit. Imagine quotes surrounding the sentence you're (probably) reacting to (and the sentence should be read with a deeply sarcastic tone), then a paragraph break.

WRT Gatorade as a superior rehydration solution.
Gatorade has 19 mmol/L of Na. I know this because I ran it through a blood gas machine once when confronted with a similar case. It has no benifits as a rehydration solution over water, other than the calories it provides from sucrose / fructose. The salt content in rehydration solutions is kept low to ensure palatability. An isotonic solution tastes horrible. The WHO oral rehydration formula is highly effective, and tastes like a salt lick.

It has no benifits as a rehydration solution over water, other than the calories it provides from sucrose / fructose. The salt content in rehydration solutions is kept low to ensure palatability

Interesting. Apparently at Pennsic, the Chirugeons(read medical staff) advise diluting Gatorade before using it as a rehydration solution. (Or so I'm informed; I haven't talked to them directly.) Is that because the sugars can cause problems?

Good question. I am guessing here, but I wonder if its the concern about setting up an osmotic diuresis from glycosuria, if enough glucose was imbibed. It would worsen the dehydration, not remedy it.

Nick: I was taught in general chemistry that water is never named systematically - one of a few exceptions. (The only other one I can remember now, unfortunately, being ammonia.)

Yeah, I was skeptical of the claims made of Gatorade too. I remember when it came to the local corner stores and people said all sorts of crap ...

As for this tragedy, yeah, consumption contests are pretty sickening ... in this case worse because there were people other than the victim who would be obviously affected. And the "doing it so the kids can have a toy" bit ...

0.9 % saline tastes good. Is that not isotonic? Have I overlooked the amount of potassium a rehydration solution needs to contain in addition to that?

re:Gatorade

I seem to recall hearing if you're severely dehydrated you should have a bowl of chicken soup because of the high salt content. I guess pickle juice would do too.

Can anyone verify or correct me?

0.9 % saline tastes good. Is that not isotonic? Have I overlooked the amount of potassium a rehydration solution needs to contain in addition to that?

Excs, tht I ntrrpt y, bt, n my pnn, ths thm s nt s ctl.