Acute water intoxication as a complication of urine drug testing in the workplace

Article Abstract:

Several industries require urine testing for the presence of drugs. Objections to urine drug testing involve scientific, ethical, and legal issues. A case is described of a 40-year-old female flight attendant who developed a medical complication associated with urine drug testing. In an effort to produce a sample, the woman drank 30 100-milliliter (mL) cups of tap water (a total of three liters) within three hours and vomited 30 mL of watery material. The patient was hospitalized after she could not urinate, developed confusion, slurred speech, and an unsteady gait. She was later diagnosed with cerebral edema, or accumulation of water in the brain, due to water intoxication. The patient was able to urinate in the hospital and was treated with saline (salt solution) and potassium. Acute water intoxication is a neurologic syndrome associated with severe hyponatremia (an abnormal decrease in blood sodium levels). The blood becomes very diluted and water moves into the brain leading to confusion, lethargy, and seizures. Water intoxication may occur after rapid consumption of large amounts of water without urinating. Bladder emptying is influenced by stress and mood, and can be hindered due to lack of privacy in public washrooms. In this case, nausea and vomiting, stress, or a cold medicine may have contributed to the release of the antidiuretic hormone vasopressin that prevents water elimination. Factors that increase the risk of water intoxication include intake of more than one liter of water and impaired urine dilution. Symptoms of impaired brain function may indicate water intoxication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Mandatory drug testing, Drug testing, Water intoxication, Overhydration

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Passive smoking on commercial airline flights

Article Abstract:

Nine volunteers who were exposed to nicotine from cigarette smoking in the cabin of a commercial aircraft were evaluated for the presence of a metabolic byproduct (metabolite) of nicotine, cotinine, in their urine for the 72 hours following exposure. In addition, the volunteers carried personal monitors which measured the level of ambient nicotine in the cabin atmosphere. In some cases, individuals in the nonsmoking areas of the cabin were exposed to levels no different from the smoking sections. The level of secreted cotinine varied with exposure to nicotine, and the urine level of cotinine was measurable in the urine of volunteers for more than 72 hours following exposure. The volunteers' subjective experience was measured, and their discomfort was found to be related to the degree of exposure and levels of excreted cotinine. Irritability of eyes and nose between the beginning and end of the study correlated with exposure levels to nicotine. The type of ventilation system varied with aircraft and was an important factor in determining the level of ambient exposure to nicotine. This report demonstrates that various factors are involved in the establishment of a microenvironment within enclosed spaces such as an airplane. Separation of smoking and nonsmoking sections of an aircraft is not meaningful from a health perspective. Passive exposure to smoking represents another contribution to the cumulative health risk from smoking.

Evaluation, Measurement, Airlines, Nicotine, Cotinine, Nonsmoking areas

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Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults

Article Abstract:

Passive smoking affects blood flow in the coronary arteries of non-smokers, according to a study of 15 smokers and 15 non-smokers. This may be one mechanism whereby passive smoking increases a non-smoker's risk of heart disease.

Blood circulation

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