We all know the importance of staying hydrated, but this is one case where you can have too much of a good thing. A recent inquest into the death of Michelle Whitehead has returned intel on the devastating consequences of excessive water consumption – but it’s also shone a light on a lack of medical protocol and awareness around the condition, of which has proven fatal for this mum of two.

45-year-old Michelle was under the care of a mental health unit following a breakdown. The inquest revealed that she exhibited signs of psychogenic polydipsia, a well-documented phenomenon in individuals with psychiatric disorders. Unfortunately, the staff failed to diagnose her condition, allowing her unsupervised access to water in her room.

“When Michelle seemingly fell asleep, staff should have realised something was very wrong, had they acted earlier Michelle would have been taken to ICU [intensive care unit] and put on a drip,” Michelle’s husband, Michael, told the BBC. “That would have saved her life. By the time they realised what was happening, the same course of action was far too late." 

Pictured: Michelle Whitehead

On the afternoon of May 5, 2021, Michelle's excessive water intake went unnoticed until it led to a state of acute overhydration, resulting in severely low sodium levels. This dangerous condition caused swelling in the brain, leading to hyponatraemic encephalopathy, acute hyponatremia, and, ultimately, Michelle's tragic demise. The inquest exposed critical lapses in monitoring and intervention by healthcare staff, as Michelle slipped into a coma without timely detection. It was only after more than four hours that a healthcare assistant noticed changes in her breathing, prompting action.

The jury's findings, based on the balance of probabilities, point to acute overhydration as the primary cause of Michelle's death, emphasising the critical importance of recognising and managing conditions like psychogenic polydipsia in mental health care settings. This heartbreaking incident serves as a stark reminder of the need for improved awareness, training, and protocols within mental health units to identify and address complications associated with psychiatric disorders. The consequences of untreated psychogenic polydipsia can be severe, and timely intervention is paramount.

The NHS trust involved has acknowledged multiple failings in Michelle's care and issued a sincere apology to her grieving family. As advocates for mental health reform continue their efforts, stories like Michelle's underscore the urgency of creating safer and more supportive environments for individuals facing mental health challenges during some of their most vulnerable moments.

For those of you here in Australia, this case may be reminiscent of the 1995 death of 15-year-old Anna Wood, who died after taking an ecstasy pill at a dance party. But contrary to popular belief, it wasn’t an overdose of the drug itself that killed her – it was the resulting urge to consume excessive amounts of water that the drug caused.

Pictured: Anna Wood

The teenager died from water intoxication or hyponatremia, where the balance of electrolytes in the body is disrupted by an overwhelming influx of water. In the case of drug-related water intoxication, we know that ecstasy reduces the kidney's ability to clear excess water from the body, making the body's threshold for excess water significantly lower. In Anna's case, the sodium levels in her bloodstream dropped dangerously low, causing her brain to swell—a condition known as cerebral oedema. 

Why Water Intoxication Occurs

While Michelle and Anna's cases vary, the results of water intoxication in both instances are a result of a number of problems: 

Dilution of Electrolytes: Consuming an excessive amount of water can dilute the electrolytes in the body, particularly sodium. Sodium is crucial for maintaining the balance of fluids in and around cells.

Cell Swelling: When sodium levels drop significantly, water rushes into cells, causing them to swell. While most cells can handle this, brain cells are particularly sensitive to swelling due to the confined space within the skull.

Symptoms of Water Intoxication:

• Nausea and Vomiting
• Headache
• Confusion
• Seizures
• Coma

Tips for Safe Hydration

While cases of water overconsumption are generally linked to other diseases and psychological conditions, it’s still worth getting the facts straight around safe hydration, since so many of us are often left confused on the topic – should we be drinking 8 glasses a day or not?

Moderation is Key: Listen to your body and drink water when you're thirsty. You don't need to force yourself to drink excessive amounts.

Consider Electrolyte Balance: If you engage in prolonged or intense physical activity, consider beverages that contain electrolytes, especially if you're sweating heavily.

Individual Needs: Hydration needs vary from person to person based on factors like age, weight, activity level, and climate. Tailor your fluid intake accordingly.

Monitor Urine Colour: Aim for a pale yellow colour in your urine, which generally indicates adequate hydration. Dark yellow or amber urine may suggest dehydration.

Sip Throughout the Day: Instead of chugging large amounts of water at once, sip water gradually throughout the day.

While staying hydrated is crucial for overall health, it's equally important to strike a balance and avoid excessive water intake. If you have specific health concerns or conditions, it's advisable to consult with a healthcare professional to determine your individual hydration needs.

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