Overhydration symptoms
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Overhydration Symptoms: Key Clinical Signs and Health Risks
General Symptoms of Overhydration and Water Intoxication
Overhydration, also known as water intoxication, occurs when the body retains more water than it can excrete, leading to an imbalance in electrolytes, especially sodium. This condition can cause a range of symptoms, from mild to severe. Common symptoms include irritability, lethargy, confusion, and in more serious cases, seizures and coma. These neurological symptoms are particularly frequent in vulnerable groups such as infants and the elderly, and are often first detected through abnormal plasma sodium or osmolality levels 19.
Hyponatremia and Neurological Effects
A major risk of overhydration is dilutional hyponatremia, where the sodium concentration in the blood drops to dangerously low levels. When serum sodium falls below 120 mmol/l, symptoms such as headache, nausea, vomiting, muscle weakness, and altered mental status may appear. Rapid development of hyponatremia can lead to severe brain dysfunction, including brain swelling (cerebral edema), increased intracranial pressure, and potentially fatal brain herniation 89. The severity of neurological symptoms is closely linked to how quickly sodium levels drop .
Physical Signs: Edema and Cardiopulmonary Complications
Physical signs of overhydration can include visible swelling (edema), especially in the legs, ankles, or around the eyes. Overhydration is also associated with cardiopulmonary problems such as shortness of breath and, in severe cases, heart failure due to fluid overload. Gastrointestinal symptoms like nausea and vomiting may also occur 28.
Overhydration in Chronic Kidney Disease and Heart Failure
In patients with chronic kidney disease or heart failure, overhydration is a common and serious problem. These patients may not always show classic symptoms like edema or rapid weight gain, making diagnosis challenging. Instead, subtle metabolic disruptions or changes in laboratory markers (such as NT-pro-BNP or Ca-125) may be the only clues .
Acute and Chronic Complications
Acute overhydration can lead to water intoxication, with symptoms such as confusion, seizures, and coma. Chronic overhydration may cause urinary bladder distension, ureter dilation, and hydronephrosis (swelling of the kidneys due to urine buildup) . In both acute and chronic cases, the risk of morbidity and mortality increases if the condition is not recognized and treated promptly .
Conclusion
Overhydration can present with a wide range of symptoms, from mild confusion and irritability to severe neurological impairment and life-threatening complications. The most serious risk is dilutional hyponatremia, which can cause brain swelling and death if not managed quickly. Physical signs like edema and cardiopulmonary symptoms may be present, but overhydration can also be "silent," especially in patients with chronic illnesses. Early recognition and careful monitoring of fluid and electrolyte balance are essential to prevent the serious consequences of overhydration 12489.
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