I had been a paramedic for about 4 years, and had thought I had seen almost every type of illness or injury I could see. Veteran medics all over are laughing at that statement, but hey, I have a right to fool myself.

We responded to a local convenience store for a person being disruptive. Upon arrival, law enforcement was there, and advised that we needed to check the patient out. After an exam, the only thing we could conclude was the possibility of some sort of brain injury or even more possibly it was some sort of illicit drug reaction.

The patient presentation was:

He was walking and talking at the scene, but was confused. Although the patient could readily say his correct name, address, and d.o.b, he could not tell us the correct year, the city he was currently in, or why he was at the convenience store. His speech was slurred, but he did not show any other signs indicating a possible stroke. He was also somewhat combative, in that he tried numerous times to walk away, and became aggressive when we tried to stop him for further evaluation. The patient’s vitals were normal, given the current circumstances, and the slightly elevated heart rate and blood pressure did not alarm us.

We eventually managed to convince the patient to allow us to transport to the ER, so we placed him on oxygen, started an IV and loaded him up. During transport, the patient had a period of unresponsiveness. The heart monitor was applied showing a sinus rhythm with an occasional pvc. It was only about a 10 minute transport time, so no further treatment was given.

Later at the station

A couple of other Paramedics, EMTs, and me were sitting around station. We had not given a lot of thought about the patient we transported earlier, as it did not seem like anything really out of the ordinary for a Friday evening.

The phone rings, and it is the emergency room. It was the charge nurse giving us an update on the patient we had brought in. Apparently, very soon after we dropped the patient off, he suffered a cardiac arrest. Despite efforts by the emergency room staff, they could not resuscitate him and he was pronounced dead. The diagnosis was Water Intoxication!

I had a hard time comprehending how someone could have died of this, so I did some reading, and a background check on our patient. From the reports of the family, the patient had recently become obsessed with drinking water as part of a diet plan. They claimed he was drinking several gallons daily, but they had never given much thought about it being dangerous. Now, I may not have been taught what water intoxication is, but with my training and some common sense, I did understand how that much water could be harmful. It dilutes just about every electrolyte in the body. Working especially against sodium levels, it causes hyponatremia. While it certainly can be dangerous, it is rarely fatal. However, in the case of our patient, untreated for weeks, this was a fatal mistake.

Along with learning about water intoxication, I also learned another important thing that night. It does not matter how long we have been doing what we do, or how many runs we see, we have NEVER “seen and done it all”.

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