Drinking water system treatment and contamination in Shatila refugee camp in Beirut, Lebanon

Drinking water at Shatila Palestinian Refugee Camp in Beirut, Lebanon is of poor quality and unpredictably intermittent quantity. We aimed to characterize drinking water sources and contamination at Shatila and determine how drinking water can be managed to reduce community health burdens. We interviewed the Popular Committee, well owners, water vendors, water shopkeepers and preschool administrators about drinking water sources, treatment methods and the population served. Water samples from the sources and intermediaries were analysed for thermotolerant faecal coliforms [FCs], Giardia lamblia, Cryptosporidium parvum and microsporidia, using immunofluorescent antibody detection for G. lamblia and C. parvum, and chromotrope-2 stain for microsporidia. All drinking water sources were contaminated with FCs and parasites. FC counts [cfu/mL] were as follows: wells [35-300], water vendors [2-178], shops [30-300] and preschools [230-300]. Responsible factors identified included: unskilled operators; improper maintenance of wells and equipment; lack of proper water storage and handling; and misperception of water quality. These factors must be addressed to improve water quality at Shatila and other refugee camps

Hyponatremia after Radioactive Iodine Treatment in Thyroid Cancer Patients

Radioactive iodine treatment (RAIT) after surgery reduces local recurrence and cancer related death. Cases of hyponatremia after preparation for RAIT have rarely been reported. We report 4 cases of hyponatremia which developed after RAIT. The cause of hyponatremia seemed to be related with over ingestion of free water which is recommended during RAIT. These cases highlighted the importance of weight adjusted water ingestion during RAIT.

Hypotonic hyponatremia by primary polydipsia caused brain death in a 10-year-old boy

Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg). The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.

Riesgo sanitario integrado por sustancias presentes en recursos hídricos de Tres Arroyos, Argentina / Integrated health risk by substances in water resources of Tres Arroyos, Argentina / Risco sanitário integrado por substâncias presentes em recursos hídricos de Tres Arroyos, Argentina

El objetivo del trabajo fue analizar el riesgo sanitario no carcinogenético a partir de ciertas sustancias (inorgánicas, fenólicas, metales pesados y pesticidas) presentes en aguas superficiales y subterráneas de la ciudad de Tres Arroyos. El análisis se realizó utilizando el modelo básico de análisis de riesgo sanitario probabilístico de USEPA considerando tres estratos de edades infantiles (5, 10 y 15 años). Se integraron escenarios de tipo residencial con recreativo, sobre la base de la exposición por la ingesta y por el contacto dérmico con el agua. En los tres estratos de edad, los resultados indican que los valores del riesgo integrado (riesgo residencial + riesgo recreativo) fueron significativos y decrecientes con relación a la edad, siendo el arsénico el principal contribuyente a través de la vía de ingesta consuntiva del escenario residencial.

The objective of this work was to analyze the non-carcinogenic health risk from certain substances (inorganic, phenolic, heavy metals and pesticides) in surface waters and groundwater in the town of Tres Arroyos. The analysis was performed using the basic model of health risk analysis considering probabilistic USEPA for children of three age groups (5, 10 and 15). Residential and recreational type scenarios were integrated, based on exposure through ingestion and dermal contact with water. In all three age strata, the results indicate that the values of the integrated risk (residential risk + recreational risk) were significant and decreasing with respect to age, being arsenic the largest contributor through the residential ingestion pathway.

O objetivo do trabalho foi analisar o risco sanitário não-carcinogênico a partir de determinadas substâncias (inorgânicas, fenólicas, metais pesados e pesticidas) presentes em águas superficiais e subterrâneas da cidade de Tres Arroyos. A análise foi feita utilizando o modelo básico de análise de risco sanitário probabilístico de USEPA, considerando crianças de três faixas etárias infantis (5, 10 e 15 anos). Foram integrados cenários do tipo residencial e recreativo, com base na exposição pela ingestão e pelo contato dérmico com a água. Nas três faixas etárias, os resultados indicam que os valores do risco integrado, (risco residencial + risco recreativo) foram significativos e decrescentes com relação à idade, sendo o arsênico o contribuinte principal através da via da ingestão consuntiva do cenário residencial.

Hyponatremia caused by excessive intake of water as a form of child abuse

Hyponatremia is the most common electrolyte disorder that requires careful management. Water intoxication with hyponatremia is rare condition that originated from overhydration. Water intoxication, also known as dilutional hyponatremia, develops only because the intake of water exceeds the kidney's ability to eliminate water. Causes of this water intoxication include psychiatric disorder, forced water intake as a form of child abuse and iatrogenic infusion of excessive hypotonic fluid. We experienced and reported a case of symptomatic hyponatremia by forced water intake as a form of child abuse.

Hyponatremia caused by excessive intake of water as a form of child abuse

Hyponatremia is the most common electrolyte disorder that requires careful management. Water intoxication with hyponatremia is rare condition that originated from overhydration. Water intoxication, also known as dilutional hyponatremia, develops only because the intake of water exceeds the kidney's ability to eliminate water. Causes of this water intoxication include psychiatric disorder, forced water intake as a form of child abuse and iatrogenic infusion of excessive hypotonic fluid. We experienced and reported a case of symptomatic hyponatremia by forced water intake as a form of child abuse.

Severe hypotension and water intoxication developed after an accidental oxytocin overdose in a morbidly obese patient undergoing cesarean section: A case report / 대한마취과학회지

We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

Fatal Water Intoxication in a Schizophrenic Patient / 대한법의학회지

We report a case of fatal water intoxication in a schizophrenic patient. A 41-year-old schizophrenic male, who was admitted to a psychiatric hospital, was found dead in the restroom of the hospital. He had drunk many bowls of tap water before. On the postmortem examination, the brain was diffusely edematous, but no apparent herniation was noted. The lung was mildly expanded with edema. The stomach and intestine were diffusely expanded, and the intestine and mesentery were extensively edematous. Bilateral hydronephrosis was observed. A subcapsular hematoma with focal cortical rupture was observed in the right kidney. The vitreous sodium was 102 mEq/l and potassium was 10.5 mEq/l.

Alteraciones bioquímicas en individuos expuestos al arsénico en el agua de bebida en Tucumán, Argentina / Biochemical alterations in individuals consuming high levels of arsenic in drinking water in Tucuman, Argentina

El objetivo de esta investigación fue evaluar los niveles del ácido siálico (S) y enzimas hepáticas en individuos que consumieron agua con arsénico (As) relacionándolos con la presencia ("I con H") o no de hepatomegalia ("I sin H"). Se incluyeron 200 individuos, 85 correspondieron al Grupo Control (GC), 32 "I con H" y 83 "I sin H" quienes habían consumido agua con niveles mayores a 0,01 mg/L. Se les tomó una muestra de sangre venosa y se les realizó el dosaje del S y de las enzimas alaninaninotransferasa (ALT), aspartatoaminotransferasa (AST), fosfatasa alcalina (FAL), gamma glutamil transferasa (GGT), bilirrubina directa (BD) y total (BT), lactato deshidrogenasa (LDH) y 5' nucleotidasa (5'Nu). En los individuos que consumieron agua contaminada se encontró un aumento de los niveles del S. En el grupo "I con H", la FAL, la GGT y la LDH se encontraron aumentadas. En el grupo "I sin H", la GGT y la LDH tuvieron niveles elevados. En los individuos expuestos al As, no se encontraron alteraciones en los otros parámetros bioquímicos estudiados y la prevalencia de hepatomegalia no fue significativa. Los cambios bioquímicos encontrados fueron compatibles con la presencia de un patrón colestásico. Estos datos muestran que la concentración del S sérico podría servir como un indicador de exposición al arsénico que podría ser utilizado en forma conjunta con otros marcadores.

The aim of this study was to investígate the relationship between the levels of serum sialic acid (S) and hepatic enzymes in individuáis who drink As contaminated water. Two hundred individuáis were selected: 85 were the control group, 32 presented hepatomegaly (I with H) and 83 did not present hepatomegaly (I without H) who had consumed drinking water containing As levels higher than O.Ol mg/L. Blood samples were collected for the determination of S and hepatic enzymes in serum: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (FAL), gamma glutamil transpeptidase (GGT), direct (BD) and total bilirrubin (BT), lactate deshydrogenase (LDH) and 5'nucleotldase (5'Nu). The populatlon exposed to As in drinking water presented high levels of S, FAL, GGT, LDH and GGT, LDH were increased in I with H and I without H respectively. No significant changes were observed in the other parameters studied. Prevalence of hepatomegaly was not significantly higher and the hepatic biochemical changes were related with the presence of cholestasis in As-exposed people. These data show that people with high As level intake would have an increased sialoprotein replacement which could be an marker with other one of the alterations caused by arsenic.

Prevalence and Risk Factors of Polydipsia and Water Intoxication in Psychiatric Inpatients

OBJECTIVES: The aims of this study are to estimate the prevalence of polydipsia and water intoxication and to identify risk factors of polydipsia and water intoxication in psychiatric inpatient. METHODS: 1,108 Psychiatric inpatients at 2 mental hospitals in Yongin city were studied from September, 2008 to January, 2009. We diagnosed'polydipsia' using staff reports(fluid intake>3L/day) or by specific gravity of urine(SPGU4%). We attempted to identify clinical characteristics of patients by reviewing their medical records. RESULTS: Two hundred forty seven patients(22.3%) were polydipsic. Sixty eight patients(6.1%) were at risk for water intoxication. The factors associated with polydipsia were lithium, smoking, younger age and increased smoking amounts. The factors associated with risk for water intoxication were valproic acid and polydipsia. CONCLUSION: Polydipsia and water intoxication in psychiatric inpatients are not rare conditions. Therefore, clinicians' attention should be paid to these conditions.

Oculohypotensive effects of foeniculum vulgare in experimental models of glaucoma.

PURPOSE: Evaluation of oculohypotensive activity of single drop application of aqueous extract of Foeniculum vulgare in experimental models of glaucoma. METHODS: The evaluation of oculohypotensive activity of Foeniculum vulgare was done in rabbits with normal intraocular pressure (IOP) and with experimentally elevated IOP. The experimental increase in IOP was achieved using water loading and steroid induced glaucoma models. RESULTS: The aqueous seed extract of Foeniculum vulgare exhibited 17.49, 21.16 and 22.03% reduction of intraocular pressure (IOP) in normotensive rabbits at 0.3%, 0.6% and 1.2% (w/v) concentrations respectively. The 0.6% concentration was further evaluated in acute and chronic models of glaucoma. A maximum mean difference of 31.20% was observed between vehicle treated and extract treated eyes in water loading model while a maximum mean IOP lowering of 31.29% was observed in steroid induced model of glaucoma. CONCLUSIONS: The aqueous extract of Foeniculum vulgare possesses significant oculohypotensive activity, which was found to be comparable to that of timolol. Further investigations into the mechanism of action, possible toxicity and human clinical trials are warranted before the Foeniculum vulgare finds place in the arsenal of antiglaucoma drugs prescribed by physicians.

Water Intoxication Following Low-Dose Intravenous Cyclophosphamide

Cyclophosphamide is frequently used for the treatment of severe lupus nephritis, but is very rarely associated with dilutional hyponatremia. Recently we experienced a case of water intoxication following low-dose intravenous cyclophosphamide. Five hours after one dose of intravenous pulse cyclophosphamide 750 mg, the patient developed nausea, vomiting, and general weakness. Serum sodium concentration revealed 114 mEq/L and her hyponatremia was initially treated with hypertonic saline infusion. Then her serum sodium concentration rapidly recovered to normal with water restriction alone. During the course of intravenous pulse cyclophosphamide therapy, one must be aware of the possibility of significant water retention.

Acute pulmonary oedema following oxytocin administration: a life threatening complication.

Water Intoxication is not a common complication of oxytocin infusion. A 26 years primigravida developed acute onset severe pulmonary oedema in postpartum period to whom oxytocin was infused for the induction of labour and to prevent postpartum haemorrhage. The relative role of oxytocin and of electrolyte-free fluids in the pathogenesis of this problem is discussed.

Hyponatremic Encephalopathy after an Intense Prolonged Physical Activity in Hot and Humid Weather

No abstract available.

Intoxicação hídrica durante histeroscopia: relato de caso / Water intoxication during hysteroscopy: case report

JUSTIFICATIVA E OBJETIVOS: Intoxicação hídrica e distúrbios eletrolíticos produzindo toxicidade sistêmica podem ocorrer durante ressecção prostática transuretral e cirurgia histeroscópica, sendo em geral causados pelo volume de líquido e pela duração do procedimento. RELATO DO CASO: Apresenta-se um caso incomum de intoxicação hídrica em uma paciente de 42 anos submetida à ressecção endoscópica de mioma uterino submucoso, com descrição do diagnóstico e do tratamento. CONCLUSÕES: A intoxicação hídrica pode ser resultado de sobrecarga líquida, sendo importante o controle cuidadoso dos líquidos empregados e monitorização clínica.

Oxytocin-induced Water Intoxication with Seizures and Altered Mental State

Water intoxication associated with hyponatremia is a rare and sometimes fatal complication of oxytocin. We report a 18-year-old primigravida who presented with vomiting, seizures, and stuporous mental state after abortion with oxytocin infusion. The serum sodium was 116 mEq/L and serum osmolality was 234 mosm/kg. The serum sodium level as well as clinical symptoms were improved after hypertonic saline infusion. We suggest that the serum electrolytes and osmolarity should be examined in patients who presenting with seizure and altered mental state with history of labour or abortion.

A Clinical Study of Acute Symptomatic Seizures in Children / 대한소아신경학회지

PURPOSE: The present study was designated to sex, age, etiology of acute symptomatic seizures, which refer to the seizure caused by specific and transient pathophysiologic abnormalities in the central nervous system and other systems, and furthermore to analyze the incidence of acute symptomatic seizures before and during hospitalization. METHODS: The medical records of six hundred and ten convulsive children under fifteen years of age, who visited the Hallym University Sacred Heart Hospital from January 1999 to May 2001, were reviewed. One hundred and fourteen cases out of them were analyzed, and febrile seizures and unprovoked seizures were excluded. RESULTS: Among six hundred and ten children who had seizure during hospitalization, one hundred and fourteen(18.7%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures. The ratio of male to female was 1:2.1 and the peak age was three or less, accounting for 93.9%. Acute symptomatic seizures were caused by acute gastroenteritis(42.0%), metabolic/toxic disturbances(34.1%), cerebrovascular diseases(8.8%), CNS infections(8.0%), hypoxemia(4.4%), brain tumors(1.8%), and others(0.9 %). Remarkably, hypocalcemia and shaken baby syndrom were up to 82.1% of metabolic/ toxic distubances and 30.0% of cerebrovascular diseases, respectively. Among the one hundred and fourteen patients, 41.2% suffered from seizures before and during hospitalization and 11.4% did not before but did during hospitalization. CONCLUSION: Eighteen point seven percent of the cases of convulsions reviewed were classified into acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures with the male to female ratio of 1:2.1 and high incidence age of three or less years. The leading causes of acute symtomatic seizures were acute gastroenteritis and hypocalcemia, comprising 70%. Shaken baby syrome and hyponatremia due to water intoxication can be prevented by public education about the danger, and central nervous system infection can be reduced by vaccine development and nationwide vaccination against the bacteria causing the central nervous system infection. In addition, appropriate prevention and management of seizure attacks are required for the patients with acute symptomatic seizures during hospitalization.

A Case of Water Intoxication and Grand Mal Seizure due to Oxytocin / 대한산부인과학회잡지

A 17-year-old primigravida, who had an elective abortion in the second trimester of pregnancy in a local clinic, was transferred to our hospital in state of status epilepticus. During the last 2-hr period immediately prior to admission the patient had an unknown number of generalized convulsions together with intermittent episodes of vomiting. Despite the administration of anticonvulsants and sedatives her condition was one of wild agitated response to stimuli, alternating with deep coma. After a tentative diagnosis of dilutional hyponatremia, she was given hypertonic saline solutions in addition to anticonvulsant therapy. Fourteen hours after her seizure, the patient was awake, alert, and cheerful but totally amnescent about the previous period. This case of severe water intoxication associated with an infusion of oxytocin reported here may serve as a reminder of the potential hazards of a widely used procedure, and of the precautions which must be observed.