Strange but true:drinking too much water can kill

喝水太多也会致死，过量喝水的隐患

In a hydration-obsessed culture, people can and do drink themselves to death.

在一个对喝水有狂热目标的文化环境中，人们会因喝水导致死亡

     by coco ballantyne on june 21, 2007（由可可巴兰在2007年6月21日所写）

Liquid h2o is the sine qua non of life, making up about 66 percent of the human body, water runs through the blood, inhabits the cells, and lurks in the spaces between. At every moment water escapes the body through sweat, urination, defecation or exhaled breath, among other routes. Replacing these lost stores is essential but rehydration can be overdone. There is such a thing as a fatal water overdose.

水是生命的必要条件，在人体中占有66%，流经血液，组成细胞并占据着细胞间隙。每时每刻水都要离开人体，通过呼气，汗液，尿液，各种排遗物和各类途径。补充这类流失的水分是必要的，但也有可能被过量进行。

 

Earlier this year, a 28-year-old california woman died after competing in a radio station's on-air water-drinking contest. After downing some six liters of water in three hours in the "hold your wee for a wii" (nintendo game console) contest, jennifer strange vomited, went home with a splitting headache, and died from so-called water intoxication.

2007年早些时候，加利福尼亚州一位28岁的女性在参加电视台喝水直播大赛后死亡。比赛是由任天堂举办，比赛的奖品是一台游戏机。（在当时一台游戏机是比较昂贵的，而任天堂的提供的奖品对于游戏爱好者有致命的吸引力）。在3小时内喝完6升水后（2 L/h > 0.96 L/h，0.96这一数字是水中毒的临界数值换算后得到），詹妮弗奇怪地呕吐，回到家后还有呕吐常见的后遗症——头疼，之后发生死亡，而死因就是所谓的“水中毒”。

 

There are many other tragic examples of death by water. In 2005 a fraternity hazing at california state university, chico, left a 21-year-old man dead after he was forced to drink excessive amounts of water between rounds of push-ups in a cold basement. Club-goers taking mdma ("ecstasy") have died after consuming copious amounts of water trying to rehydrate following long nights of dancing and sweating. Going overboard in attempts to rehydrate is also common among endurance athletes. A 2005 study in the new england journal of medicine found that close to one sixth of marathon runners develop some degree of hyponatremia, or dilution of the blood caused by drinking too much water.

由水造成死亡的例子不胜枚举，令人唏嘘不已。2005年加利福尼亚州立大学一个叫Chico的兄弟会（兄弟会是存在于美国、加拿大等国家的一种社团组织，以狂野派对闻名，欺凌事件不绝，入会仪式甚至不时造成死亡事件）让一个21岁的男性在做完多轮俯卧撑之后喝入大量的水，而地点在一个冰冷的地下室。另一个死亡事件是一个俱乐部成员在在服用摇头丸之后（摇头丸一般是指含有致幻型苯丙胺类兴奋剂成分的片剂和丸剂。服用后主要表现为活动过度、摇头扭腰、嗜舞、妄想、不知羞耻、性冲动及幻觉和暴力倾向，故俗称为“摇头丸”）长时间跳舞，大汗淋漓，未来得及补水就已死亡。极端性的补水在耐力运动员中较为普遍。2005年新英格兰医学期刊的一篇研究表明接近1/6的马拉松运动员有不同水平的低钠血症，血液过度稀释，而究其原因是由于喝入太多水。

 

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Hyponatremia, a word cobbled together from latin and greek roots, translates as "insufficient salt in the blood." quantitatively speaking, it means having a blood sodium concentration below 135 millimoles per liter, or approximately 0.4 ounces per gallon, the normal concentration lying somewhere between 135 and 145 millimoles per liter. Severe cases of hyponatremia can lead to water intoxication, an illness whose symptoms include headache, fatigue, nausea, vomiting, frequent urination and mental disorientation.

低钠血症，是拉丁语和希腊词根混合而成，被翻译为“血液低盐”，从定量的角度来说，低钠血症意味着血钠浓度低于135 m mol/L(大约是3.26 g/L)。而正常的血钠浓度应在135 m mol/L到145m mol/L之间。严重的低钠血症会导致水中毒，水中毒的常见症状包括头痛，疲劳，恶心，呕吐，尿频和精神错乱。

 

In humans the kidneys control the amount of water, salts and other solutes leaving the body by sieving blood through their millions of twisted tubules. When a person drinks too much water in a short period of time, the kidneys cannot flush it out fast enough and the blood becomes waterlogged. Drawn to regions where the concentration of salt and other dissolved substances is higher, excess water leaves the blood and ultimately enters the cells, which swell like balloons to accommodate it.

在人体中肾脏控制着水，盐的含量（这从另一个角度表明卖肾行为对人体的巨大损害，卖肾以及其他器官是对生命极不负责任的行为）以及通过数万个肾小管时的筛血功能。当一个人在短时间喝入大量水，肾脏的筛血速率将会小于喝入水的速率，血液将会出现“洪水”（纯质水太多导致相对盐含量下降）。出现洪水的地方的核心区域将会有更多的盐和溶质，而多余的水会离开血液最终进入到细胞之中，使细胞肿胀来容纳过多的水。

 

Most cells have room to stretch because they are embedded in flexible tissues such as fat and muscle, but this is not the case for neurons. Brain cells are tightly packaged inside a rigid boney cage, the skull, and they have to share this space with blood and cerebrospinal fluid, explains wolfgang liedtke, a clinical neuroscientist at duke university medical center. "inside the skull there is almost zero room to expand and swell," he says.

大多数细胞都有一定的空间（这空间是微观概念，对于宏观视角来讲仍然是末如草芥）来伸展（大部分是控制细胞外液的含量稳定），但对于大脑中的细胞——主要是“神经元”

而言却并非如此。（神经元，下面都用脑细胞代替）脑细胞被紧紧固定在刚性骨笼里（所谓刚性就是物体保持形状不变，外力过大就会毁坏物体的特性），就是头颅骨，并且不得不将自己的空间也匀出一部分来使血液和脑脊液流动。杜克大学医学中心临床神经学家沃尔夫冈·列得特克解释道， （杜克大学是世界顶级的研究性大学，美国南方最顶尖的高校，著名校友有蒂姆·库克，梅琳达·盖茨等）在脑颅之中几乎没有空间来胀大。

 

Thus, brain edema, or swelling, can be disastrous. "rapid and severe hyponatremia causes entry of water into brain cells leading to brain swelling, which manifests as seizures, coma, respiratory arrest, brain stem herniation and death," explains M. Amin Arnaout（Mohammed Amin Arnaout）, chief of nephrology at massachusetts general hospital and harvard medical school.

因此脑水肿或脑胀大，将是灾难性的。”快速而又严重的低钠血症导致脑细胞水肿，进而导致脑积水，伴随的症状是为癫痫（病状表现为发作性运动、感觉、自主神经、意识及精神障碍）发作，昏迷，呼吸停止，脑干受压甚至是死亡”。穆罕默德·阿民·阿纳欧特解释，他是马萨诸塞州中心医院和哈佛医学院肾脏学首席顾问。

 

Where did people get the idea that guzzling enormous quantities of water is healthful? A few years ago heinz valtin, a kidney specialist from dartmouth medical school, decided to determine if the common advice to drink eight, eight-ounce glasses of water per day could hold up to scientific scrutiny. After scouring the peer-reviewed literature, valtin concluded that no scientific studies support the "eight x eight" dictum (for healthy adults living in temperate climates and doing mild exercise). In fact, drinking this much or more "could be harmful, both in precipitating potentially dangerous hyponatremia and exposure to pollutants, and also in making many people feel guilty for not drinking enough," he wrote in his 2002 review for the American journal of physiology—regulatory, integrative and comparative physiology. And since he published his findings, valtin says, "Not a single scientific report published in a peer-reviewed publication has proven the contrary."

那么人们是从哪里得到喝大量水是十分健康这一观点的呢？许多年前达特茅斯医学院（达特茅斯学院（Dartmouth College）成立于1769年12月13日，位于美国新罕布什尔州汉诺威镇。达特茅斯是八所常春藤联盟（Ivy League School）名校之一，也是建校早于美国建国的九所殖民地学院（Colonial Colleges）之一。）的一位肾脏学专家亨氏·瓦尔丁决定去确定寻常的建议——每天喝8杯8盎司（大约1.7L, 水中毒的临界值是0.96L/h）是否能够经得起科学的验证。在大量查阅同行文献后，瓦尔丁得出结论：并没有科学表明8ⅹ8的完美组合是正确的（对健康的生活在温和环境中做温和运动的人来讲）。实际上喝的少或多对人体都有危害，这些行为都会在生理上潜在地形成低钠血症并且会加大人体内部直接暴露在空气中的风险，在心理上人们也会因为没有喝够足量水而心生愧疚。瓦尔丁在他2002年对美国生理学杂志一篇文章——调节，综合与比较生理学的评论中写下。在出版他的发现后，瓦尔丁说“在行业中并没有一篇论文已经证明与我相反的结论”

 

Most cases of water poisoning do not result from simply drinking too much water, says joseph verbalis, chairman of medicine at Georgetown university medical center. It is usually a combination of excessive fluid intake and increased secretion of vasopression (also called antidiuretic hormone), he explains. Produced by the hypothalamus and secreted into the bloodstream by the posterior pituitary gland, vasopressin instructs the kidneys to conserve water. Its secretion increases in periods of physical stress—during a marathon, for example—and may cause the body to conserve water even if a person is drinking excessive quantities.

大多数水中毒的情况并不仅仅只是因为短时间喝下大量水，约瑟夫·帕林利斯说。他是乔治敦大学医学中心医药学主席（乔治敦大学，主校区在美国华盛顿特区白宫和国会大厦旁，是世界著名私立研究型大学，有历史悠久的外交学院史，中国外交部现任部长王毅曾在此就读。）约瑟夫解释道“多数水中毒的原因往往是由于大量液体的摄入而造成的血管升压素分泌增加，也就是抗利尿激素”（抗利尿激素是人体产生的激素，适量的作用效果会加强肾脏对原尿中纯质水的再吸收）抗利尿激素有下丘脑产生，之后通过神经纤维运输到脑垂体，再由脑垂体释放后作用于肾脏而加强其保水作用。抗利尿激素加强保水作用的机理在身体压力期比较显著（也就是在运动期间），特别是马拉松。而在这段时间即使喝入大量水，人体也会大量保存下来，进而造成身体普遍性的积水。

 

 

Every hour, a healthy kidney at rest can excrete 800 to 1,000 milliliters, or 0.21 to 0.26 gallon, of water and therefore a person can drink water at a rate of 800 to 1,000 milliliters per hour without experiencing a net gain in water, verbalis explains. If that same person is running a marathon, however, the stress of the situation will increase vasopressin levels, reducing the kidney's excretion capacity to as low as 100 milliliters per hour. Drinking 800 to 1,000 milliliters of water per hour under these conditions can potentially lead a net gain in water, even with considerable sweating, he says.

健康的肾脏每小时可以排出800ml到1000ml的水，按照这样粗略计算，不难得出一个人以800ml/h到1000ml/h的速率将不会有水的盈余，帕林利斯解释道。如果同样一个人正在跑马拉松，下丘脑产生抗利尿激素的水平会上升，这将减弱肾脏的排出能力至少100ml/h。在这些情况之下，仍然保持这样的速率喝水将会导致水富足，有可能伴随有大量汗液涌出。（从某种意义来讲，吃饭太快也会流汗，尤其是在使用水含量丰富的食物）

 

While exercising, "you should balance what you're drinking with what you're sweating," and that includes sports drinks, which can also cause hyponatremia when consumed in excess, verbalis advises. "if you're sweating 500 milliliters per hour, that is what you should be drinking."因此在锻炼时，你应该平衡的并不是自己逼迫下的想法，而是尊重事实，尊重科学，平衡汗液与摄入水的量。运动时摄入的也自然包括运动饮料，当然即使是运动饮料，过量摄入也有低钠血症诱发的风险，而这些更适合每小时流汗500ml的人，并非是在跑一圈之后平静如水的你。

 

But measuring sweat output is not easy. How can a marathon runner, or any person, determine how much water to consume? As long as you are healthy and equipped with a thirst barometer unimpaired by old age or mind-altering drugs, follow verbalis's advice, "drink to your thirst. It's the best indicator."

我们聊了那么多，但实际上去实现却并不容易。比如说，如何去测定马拉松跑者，或任何一个人有多少水被排出？可能会有方法，但在实现之前，职业运动员将会更尊重自己的感觉。对于我们来讲，只要你是健康的，只要你有一个没有被年龄或精神类药物所侵蚀的渴觉中枢，那么就在你稍微口渴时喝水。这就是最好的建议，而不是8ⅹ8喝水决定论

 

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What a pity, I can’t contact the author coco Ballantyne . I am sorry to translate your article without your credit. If you can see this ,I would like to pay you with my tiny wallet. The email is 2922377320@qq.com. Many thanks for you.

 

 

  最后补充几点:

一.  按《中国居民膳食指南2016》的建议：每人每天应饮水1500~1700ml。根据我们日常使用的杯子容量换算，也就是我们常说的“8杯水”。

但是，并非每天都要喝8杯水，我们需要根据自己的饮食习惯，环境，出汗等情况来调整：

如运动量大，大量出汗，则需多喝水

在日常饮食中，如蔬菜、水果等摄入了足够的水，那么就不必一定要喝8杯。

总而言之，对于大多数健康人来说，喝多少水这个问题，不要纠结8杯水，根据自己的情况个性化调整，想喝就喝，别总是不喝就是了。

一些患有肾病、心脏病、肝病的病人，需要遵从医生的指示来限制他们的饮水量。

二.杯子的含量是不一样的，所以仅仅通过八杯水来衡量喝水问题是片面无知的，因为从某种意义来讲水是有毒的。我们更应该是去尊重自己的真实感觉，而非一个别人的凌驾的“智论”。

三.对于人体喝水最大值的计算中，我们忽略睡觉的8个小时，按照16小时计算。那么总量是0.96L/h*16h=15.36L。这是非常夸张的数值，也就是在平衡肾脏利尿速率，人体的调节能力非常强，但这是建立在时刻以16ml/h的速率喝水，显然这又是不科学的。那么讨论以容器含量为被除数的除法运算，以500ml来讲，（500ml）/（16ml/min）=31.25min，但是这也会导致有将近500ml的尿量会在半小时内被排出。而这又太频繁，不妨扩大1.5倍，也就是两小时内喝完一杯水，并排尿一次是比较科学而合理的。

四.水中毒 的发生是由于人体肾脏的持续最大利尿速度是每分钟16毫升，一旦摄取水分的速度超过了这个标准，过剩的水分会使细胞膨胀，引起 脱水 低钠症，一般会导致 头晕 眼花、 呕吐 、心跳加快等症状，严重的会出现痉挛、昏迷甚至危及生命。

五.保持人体的生理舒适度就是最健康的状态，并非满足一个遥不可及的幻想。