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Water Intoxication
Written by: Grace Auchstetter • 2022 Scholar
History
Journey is a 4-year-old, female-spayed, blue merle, border collie who was presented to IVS as a triage for neurologic concern. Journey arrived to IVS after she spent the day at the river and drank a large amount of water in a short amount of time. There was concern due to neurologic dysfunction, hypersalivation, vomiting, and abnormal mentation. When they first arrived back to the campground, Journey started having diarrhea which was followed by facial twitching, salivating, and vomiting up food, water, and sand while not acting like herself.
Physical Exam
Temperature: 99.2 (normal 100-102.5)
Heart Rate: 132 (normal 60-160)
Respiration: panting- could not obtain normal respiration rate (normal 10-40)
MM: pale pink, <2 CRT
Weight: 20.8 kg (45.76 lb)
Upon examination, Journey was hypersalivating with pale pink mucus membranes, had bilaterally responsive and appropriate pupillary light response, her menace response was present, soft/non-painful abdomen, no arrythmia or murmur noted, clear lung sounds, and was noted for having a dull but responsive response to neurologic stimuli with conscious proprioception present on all four limbs. Abdominal radiographs showed a dilated stomach with no foreign material or obstruction.
Bloodwork performed at 6:33 PM on 6/28
PCV (packed cell volume) was 65%. The normal value for a dog is between 35-55%, a high PCV can be indicative of dehydration and/or a lung/heart disease.
BG (blood glucose) was 156 mg/dL. The normal value for a dog is between 100-250 mg/dL.
Lactate was 3.5 mmol/L. The normal value for a dog is less than 2 to 2.5 mmol/L, a slight increase is between 3 to 5 mmol/L, and 5 to 8 mmol/L is considered moderately increased.
Sodium: 143 mEq/L (normal values 144-160 mEq/L) indicating that she is hyponatremic.
Potassium: 2.6 mmol/L (normal values 3.5-5.8 mmol/L) indicating that she is hypokalemic.
Chloride: 99 mEq/L normal values 109-122 mEq/L) indicating that she is hyperchloremic.
*all other values were within normal range after completing the CBC (complete blood count) and serum chemistry*
Differentials
Water toxicosis, atypical Addison’s, gastroenteritis secondary to dietary indiscretion. Due to the electrolyte imbalance, both water toxicosis and an atypical Addisonian crisis were high on the differential list. However, given the history of this patient drinking an abnormal amount of water in a short amount of time, water intoxication was higher on the list.
Treatment
Dr. Rupiper started by administering a 300 ml fluid bolus of Phylyte over 15 minutes to rebalance the electrolytes. She then administered 3 ml of Cerenia IV to offset the nausea that Journey was experiencing. After the 300 ml fluid bolus, Dr. Rupiper set Journey’s maintenance fluid level to 50 ml/hour. Journey was then prescribed 3 ml of Maropitant IV every 24 hours and 2 mg/ml (10.4 ml) Ondansetron IV every 8 hours to aide with her nausea and combat her symptoms of vomiting.
Journey’s electrolytes were ordered to be checked in 12 hours and if her nausea improved enough for her eat food, she was ordered to be discharged in the morning.
Re-check Bloodwork at 6:16 AM on 6/29
Sodium: 153 mEq/L (normal values 144-160 mEq/L)
Potassium: 4.3 mmol/L (normal values 3.5-5.8 mmol/L)
Chloride: 113 mEq/L (normal values 109-122 mEq/L)
Discharge
Journey was discharged once her nausea had subsided and after her electrolytes were confirmed to be within normal ranges. She was then offered food which she ate, and the owners noted that she was back to her original self.
Summary
Water intoxication can occur when a dog intakes a large amount of water in a short amount of time, creating an electrolyte imbalance within cells. One electrolyte in particular, sodium, can cause severe neurologic disruption. When sodium levels become too low this is called hyponatremia and can cause cells to swell. This can become very dangerous especially to cells located within the CNS (central nervous system) which can lead to irreversible brain damage and even death. Neurologic symptoms such increased salivation, loss of coordination and abnormal mentation are all symptoms of an electrolyte imbalance due to water intoxication.
Water intoxication and Addison’s Disease both present as an electrolyte imbalance of low sodium (hyponatremia) which is why both were high differentials for this case. However, Addison’s patients also present with increased potassium levels (hyperkalemia). Addison’s Disease is an autoimmune disease that results in the body destroying the adrenal cortex which requires more diagnostics and treatment compared to water intoxication. Under normal cellular conditions, potassium is in higher concentration inside of the cell and sodium is in higher concentration outside of the cell. However, when there is an imbalance between either one of these ions along the cell membrane, it can have major health implications. In this case, Journey’s sodium levels were depleted which caused water to be pulled into the cell towards the potassium since water follows solutes, and resulted in cellular swelling.
Water intoxication can present very acutely and needs to be treated by a veterinarian as soon as symptoms occur to help re-establish the electrolyte imbalance. It is very dangerous to leave water intoxication untreated, so it is crucial to keep an eye on your pets when playing in areas with water!
Resources
About the Author Vets Now Team Member Our emergency vets, et al. “What Is Water Intoxication in Dogs and How Can I Prevent It?” Vets Now, 22 Oct. 2021, https://www.vets-now.com/pet-care-advice/water-intoxication-in-dogs/.
“Anemia in Dogs: VCA Animal Hospital.” Vca, https://vcahospitals.com/know-your-pet/anemia-in-dogs#:~:text=The%20most%20common%20test%20is,dog%20is%20generally%20considered%20anemic.
Berger, Sarah. “Lactate Level in Dogs: Bloat in Dogs: Gastric Dilatation Volvulus (GDV): GDV: Canine Lactate: Blood Lactate in Dogs: Blood Lactate Levels in Dogs.” MedVet, 23 Mar. 2018, https://www.medvetforpets.com/understanding-blood-lactate-levels-in-dogs-with-gastric-dilatation-volvulus-gdv/#:~:text=The%20normal%20lactate%20blood%20level,to%208%20is%20moderately%20increased.
Flaim, Denise. “Can Dogs Drink Too Much Water? the Dangers of Water Intoxication.” American Kennel Club, American Kennel Club, 9 June 2021, https://www.akc.org/expert-advice/health/can-dogs-drink-much-water-dangers-water-intoxication/.
“Glucose Curves for Dogs.” Vetsulin, https://www.vetsulin.com/dogs/glucose-curves.aspx.
“Hematocrit Test.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Dec. 2021, https://www.mayoclinic.org/tests-procedures/hematocrit/about/pac-20384728#:~:text=A%20higher%20than%20normal%20hematocrit,Lung%20or%20heart%20disease.
Vsadmin. “Water Intoxication in Dogs.” Centennial Animal Hospital, 9 Sept. 2021, https://www.centennialanimalhospital.com/water-intoxication/.
