Infants and Water Intoxication

I also see this as a problem in my practice.



The Dangers of Too Much Water

In recent years, cases of water intoxication in babies have been reported with increasing frequency, particularly in poor, urban areas. An article from the electronic pages of Pediatrics describes 2 recent case studies and a retrospective chart review of 25 other infants hospitalized in due to hyponatremic seizures, associated with water intoxication.

Water intoxication is characterized by a spectrum of symptoms, including irritability or sleepiness, hypothermia, edema, and seizures. Typically, these symptoms follow a rapid fall in serum sodium levels, resulting from an overload of solute-free water that increases total body water by 7-8% or more. In calculating excess total body water in their patients, the authors found that an infant who consumes 260 to 540 mL of solute-free water may develop symptoms over a relatively short period of time. Yet, they emphasize that these estimates are crude and not well- correlated with the patient’s age. Infants less than 6 months of age are particularly susceptible, perhaps because they are unable to excrete as much water per unit time as older children and adults. In all of the cases reviewed in this article, infants had been given at least one form of solute-free water: 63% were given tap water; 15%, sugar water; 15%, tea, soda or Kool-aid; and 26% overly dilute formula. In the 2 most recent cases, infants were fed commercial bottled water, which was a relatively inexpensive product marketed for babies. Since this report, the FDA has recommended that such products bear labels reminding consumers that the water should not be used as an electrolyte solution. Yet, the print on these containers is small, and many stores continue to stock the products next to oral electrolyte solutions.

Although the reasons for the increased frequency of water intoxication cases are not known, some feel that changes in infant formula resulting in lower sodium content could be involved. Moreover, poverty, care giver inexperience, and lack of proper instruction from health care providers have been implicated in almost all of the cases. For these reasons, health care providers should continue to spend the extra time to educate patients about optimal infant feeding practices and the potential hazards of misusing bottled water products.

Source: Bruce, R.C. and R.M. Kliegman (1997) Hyponatremic seizures secondary to oral water intoxication in infancy: association with commercial bottled drinking water. Pediatrics 100 (6), p e4. ( http://www.pediatrics.org).