Table 2.
Published reports consistent with HAWLAH. In all cases, patients drank water. No relevant medical history reported except obstructive sleep apnoea for the 2011 case [31]
| Year | Age (years)/sex | Circumstances | Total volume (L)/time (h) | Estimated volume drunk in 20 min (L) | Initial natremia (mmol/L) | Clinical symptoms/outcome |
|---|---|---|---|---|---|---|
| 1983 [32] | 40/F | Drank a small amount of diluted household bleach. Poison unit advised to drink large amounts of fluid | 15/2 | 2.5 | Initial: 111 (2 h after onset of symptoms), 24 h later: 129 | Early: vomiting, confusion, incoherent speech, convulsion. Late: no response to painful stimuli, pulmonary oedema, cerebral and cerebellar oedema. Outcome: death |
| 1985 [33] | 21/F | Ultrasound preparation: 42 glasses | 10/min | ND | Initial: 127, later (after treatment): 135 | Early: headaches, nausea, vomiting, restlessness, tingling in limbs, fell asleep, mother found her not breathing and unresponsive. Late: confused, bizarre behaviour, non-responding, screaming incoherently. Outcome: recovery |
| 1988 [34] | 80/F | Fasting for ultrasound preparation | 4/h | ND | Initial: 119, 24 h later: 128 | Early: confused and uncooperative. Outcome: recovery |
| 1991 [35] | 40/F | Urine drug test according to Federal Aviation Administration rules | 3/3 | 0.33 | Initial: 121, 24 h later: 140 | Early: vomiting, confusion, slurred speech, unsteady gait. Outcome: recovery |
| 2002 [36] | 20/F | Urine drug test while under observation | 10–12/2–3 | 1.1–2 | Initial: 123, 5 h later: 126 | Early: dizziness, headache, incontinence, jerky movements, lost consciousness. CT: cerebral, cerebellar oedema. Late: no response to deep pain, absent gag/corneal reflexes, fixed, dilated pupils. Chest X-ray: diffuse interstitial oedema, increased cardiac enzymes, echocardiogram showed severe dilated cardiomyopathy, diffuse global hypokinesis. Outcome: death |
| 2011 [31] | 37/M | Urine drug test while under observation | 14/3 | 1.5 | Initial: 122, 90 min later: 132 | Early: abdominal pain, acting confused. Late: restless, inarticulate, ‘dry heaves’, ‘seizure-like activity’. Outcome: recovery |
| 1999 [37] | 18/M | Army basic training. Hot day, symptoms confused with dehydration. First drank 8 L in 5 h, then 5 L in 2 h and early symptoms began. Then 2 L in 2 h and 10 L in 90 mina | 20–25/8–11 | 0.53 | Initial: 121 (4 h after onset of symptoms), ICU: 115, 12 h later: 145 | Early: vomiting, dizziness, throbbing headache. Late: gait unsteady, confused, lethargic, loss of consciousness, acute respiratory distress, coma, cardiac arrest, brainstem oedema. Outcome: death |
M: male; F: female; ND: no data; ICU: intensive care unit.
aThis is a complex case and it may be disputed whether it corresponds to HAWLAH. However, the misdiagnosis, administration of 10 L of water in 90 min and natremia values suggest that the final episode was HAWLAH.