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Responders: Robert E. Cosgray, RNC, BSN, MA; Mary Ann Boyd, DNS, RN
Water intoxication can be a lifethreatening phenomenon if left unchecked or unmonitored. The cause is not fully understood, and unfortunately little is documented about the cause. What little is documented relates to isolated cases and not necessarily the assessment and treatment of similar groups.
The treatment setting must depend on what the assessment reveals. If the assessment reveals a life-threatening situation, the patient must be isolated in an inpatient setting for further assessment, treatment, and education. If patients or their significant others do not receive similar education, treatment, or psychoeducation, failure or relapse will occur.
Inpatient assessments and interventions are currently determined by exacerbation of behavioral patterns as evidenced by restlessness, pacing, increased talking, mounting irritability, and hypoactivity. The accompanying spiraling psychotic behavior will commonly reveal such laboratory findings as lowered sodium electrolyte levels, serum osmolality, and urine specific gravity.
Fluid limitation remains the cornerstone of the treatment for water intoxication. An environmental limitation used as a control variable is limiting access to fluids. This is monitored by the nursing staff through the intermittent dispensing of fluids, which cannot exceed 3,000 mL/day. There is continuous supervision of restroom facilities and meals. In addition, laboratory monitoring devices are instituted that monitor serum electrolytes and osmolality once a week initially, and once every other week thereafter. A urine specific gravity is done weekly on each client to determine compliance with fluid intake. Behavioral/physiological monitoring forms on each client are maintained on an ongoing basis.
A group psychoeducational approach assists patients suffering from water intoxication in assuming control over negative behavior, which manifests the need for excessive fluid intake. Dynamics of the psychoeducational approach also include providing opportunities to discuss why fluid restrictions are needed, clarify ideas about the necessity for fluid restriction, and explain in behavioral terms the consequences of fluid intoxication. This also includes recognition of symptoms such as increased irritability and demanding behavior.
Another objective is to assist patients in developing sensitivity to and awareness of the negative behaviors that trigger excessive fluid intake so that those behaviors can be modified. In a group setting, patients discuss methods of controlling excessive water intake, such as the use of sugarless gum and talking with...