Seizures and delirium in a trekker: the consequences of excessive water drinking?

Seizures and delirium in a trekker: the consequences of excessive water drinking?To the Editors: Backer et all have described hyponatremia and its pathophysiology in hikers in a hot environment in the Grand Canyon National Park.Zafren 2 also reported a case of hyponatremia in a cold environment in Alaska.Although many people hike in Nepal, we believe this case is the first documented report of seizure and delirium due to hyponatremia in a hiker in Nepal. Case reportA 28-year-old athletic American woman was trekking with her friend at low altitude around 1000 m in Eastern Nepal when she developed headache, fatigue, and blurred vision followed by confusion, delirium, and seizures.She was hiking in a hot and humid environment and trying to do a 2-day trek in 1 day.She was sweating profusely and noticed granules of salt on her clothing due to the sweat drying up.There was at least a 6-hour interval between the onset of her headache and dizziness and the onset of confusion.During this time, she continued to drink water ("pound water" as she called it).She strongly believed in drinking plenty of fluids (over 5-6 L) anytime she was working out, and she felt that the headache and dizziness this time could be overcome by drinking even more water.She drank about 10 L of water and ate only some saltless watery noodle soup during that day.The headache and dizziness persisted and confusion developed.She was seen by a local shaman, but she continued to deteriorate.At this time, her trekking partner helped to organize a helicopter rescue to Kathmandu.Her initial physical examination when one of us arrived by helicopter showed a semicomatose woman moving her extremities at random and unresponsive to verbal commands.Her temperature was 39°C, her systolic blood pressure was 110 mrn Hg, and her pulse was 55 beats/min and thready.Her respirations were labored at a rate of 20/min.She had roving eye movements, flat fundi, and nonicteric sclera.Her thyroid was normal, but her neck was slightly stiff on flexion.Her ear, nose, throat, chest, heart, and abdominal examinations were normal.Her skin was warm without petechiae.