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Lorry Schoenly, PhD, RN, CCHP Correctional Healthcare
with Lorry Schoenly, PhD, RN, CCHP


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Water intoxication and inmates: Signs to watch out for

Inmates with chronic mental illnesses, especially schizophrenia, are particularly prone to water intoxication

Generally, you can’t get too much water. It hydrates cells and provides the basis for the body’s waste management and blood production. However, there are times when the hydration mechanism goes haywire and too much water overpowers the normal fluid balance in the body. Although this is rare, over hydration, sometimes called water intoxication, can happen and lead to a cascade of life-threatening conditions. Inmates with chronic mental illnesses, especially schizophrenia, are particularly prone to water intoxication. Be on the look-out for signs of this condition if you work with this inmate population.

Recently, I have reviewed a case involving water intoxication in a jail setting. Fortunately officers saw changes in inmate behavior and alerted the mental health nurse in time for early intervention and recovery. However, in a case moving through the court system, signs of this medical condition were not picked up by officers or health care staff. The inmate eventually collapsed and died.

Causes of water intoxication
The medical term for the condition leading to water intoxication is psychogenic polydipsia (PPD). Patients with this condition have an uncontrolled need to drink huge volumes of water. This increased water dilutes necessary electrolytes, especially sodium. Although the underlying causes of the condition are still unclear, those with chronic and long-term psychiatric conditions, especially schizophrenia, are prone to it.

Signs of water intoxication
The following signs of over-hydration have been noted
• Compulsive fluid consumption
• Nausea and vomiting
• Increasing confusion
• Difficulty walking or balancing
• Drowsiness

Later stages of the condition can involve seizures, coma, and death.

Responses to water intoxication
This condition is diagnosed through a careful evaluation of potential causes. Treatment usually involves fluid restriction, medication, and behavioral management. The very best intervention is to alert health care staff of a need for evaluation and intervention. Consider this condition any time you see compulsive drinking behaviors by any inmate.

If you have responsibilities for mentally ill inmates, understanding and responding to compulsive water drinking is an important part of inmate monitoring. By intervening and initiating a mental health evaluation, you can prevent injury and death.

Have you had an experience with water intoxication in your custody setting? Share your thoughts in the comments section of this post.

About the author

Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.

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