1/6. Fatal child abuse by forced water intoxication.BACKGROUND: Although water intoxication leading to brain damage is common in children, fatal child abuse by forced water intoxication is virtually unknown. methods: During the prosecution of the homicide of an abused child by forced water intoxication, we reviewed all similar cases in the united states where the perpetrators were found guilty of homicide. In 3 children punished by forced water intoxication who died, we evaluated: the types of child abuse, clinical presentation, electrolytes, blood gases, autopsy findings, and the fate of the perpetrators. FINDINGS: Three children were forced to drink copious amounts of water (over 6 L). All had seizures, emesis, and coma, presenting to hospitals with hypoxemia (PO2 = 44 /- 8 mm Hg) and hyponatremia (plasma Na = 112 /- 2 mmol/L). Although all showed evidence of extensive physical abuse, the history of forced water intoxication was not revealed to medical personnel, thus none of the 3 children were treated for their hyponatremia. All 3 patients died and at autopsy had cerebral edema and aspiration pneumonia. The perpetrators of all three deaths by forced water intoxication were eventually tried and convicted. INTERPRETATION: Forced water intoxication is a new generally fatal syndrome of child abuse that occurs in children previously subjected to other types of physical abuse. patients present with coma, hyponatraemia, and hypoxemia of unknown etiology. If health providers were made aware of the association, the hyponatremia is potentially treatable.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. hyponatremia associated with overhydration in U.S. Army trainees.This report describes a series of hyponatremia hospitalizations associated with heat-related injuries and apparent over-hydration. Data from the U.S. Army Inpatient Data System were used to identify all hospitalizations for hyposmolality/hyponatremia from 1996 and 1997. Admissions were considered as probable cases of overhydration hyponatremia if this was the only, or primary, diagnosis or if it was associated with any heat-related diagnosis. Seventeen medical records were identified, and the events leading to hospitalization were analyzed. The average serum sodium level was 122 /- 5 mmol/L (range, 115-130 mmol/L). All 17 patients were soldiers attending training schools. Seventy-seven percent of hyponatremia cases occurred in the first 4 weeks of training. Nine patients had water intake rates equal to or exceeding 2 quarts per hour. Most patients were in good health before developing hyponatremia. The most common symptoms were mental status changes (88%), emesis (65%), nausea (53%), and seizures (31%). In 5 of 6 cases in which extensive history was known, soldiers drank excess amounts of water before developing symptoms and as part of field treatment. The authors conclude that hyponatremia resulted from too aggressive fluid replacement practices for soldiers in training status. The fluid replacement policy was revised with consideration given to both climatic heat stress and physical activity levels. Field medical policy should recognize the possibility of overhydration. Specific evacuation criteria should be established for exertional illness.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/6. child abuse: acute water intoxication in a hyperactive child.A 4-year-8-month-old boy was brought to our emergency department with coma and seizure. Initial physical examination showed evidence of physical child abuse and sudden body weight gain of 3.4 kg in one day. The laboratory results showed normal renal function with severe hyponatremia and the MRI study showed diffuse brain swelling. All of these findings were compatible with the diagnosis of acute water intoxication. Careful history taking from the boy and his parents separately confirmed the course of chronic polydipsia with acute compulsive water drinking. After clinical assessment and follow-up by psychiatrist, the patient was diagnosed with hyperactivity disorder. We present this case and show the possibility of correlation between compulsive water drinking, child abuse and hyperactivity disorder on acute water intoxication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. neuroleptic malignant syndrome in organic brain disease and physical illness.The neuroleptic malignant syndrome is a serious complication associated with the use of antipsychotic drugs that has received a great deal of interest in recent times. Although its aetiology has not been fully understood, it often occurs in association with underlying brain disease and physical debilitation. Two such cases are described. The various hypotheses concerning the aetiology and pathogenesis of this condition are also discussed.- - - - - - - - - - ranking = 2.5keywords = physical (Clic here for more details about this article) |
5/6. Acute brain edema due to water loading in a young woman.Increased intracranial pressure developed in a mentally and physically normal patient following ingestion of 30 glasses of water as a voluntary preparation for ultrasonic gynecological examination. hyponatremia resulted and induced brain edema which provoked increased intracranial pressure. hyponatremia was treated by intravenous infusion of hypertonic NaCl and mannitol solutions. Corticosteroids were added and continued for a week. The patient totally recovered 4 days after admission.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/6. Complications of fluid overload in heat casualty prevention during field training.Several troops evacuated from field training sites as heat casualties were determined to be fluid overload casualties. Common features of this paradoxical syndrome were dilute primary electrolytes with physical exhaustion and muscle weakness after rapid free water intake. A pattern of skipping meals, working in a hot and humid environment, and consuming large volumes of water as "protection against becoming a heat casualty" predisposed these troops to the physical impairment that they intended to avoid. The mechanisms leading to both appropriate and inappropriate physiological responses to free water replacement are discussed as a basis for avoiding this specific heat casualty situation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |