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The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946\u20132019) were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46\u00b116 years (95%\u2009CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L\/day (95%\u2009CI 8.9 to 12.2 L\/day) and 118\u2009mmol\/L (95%\u2009CI 116 to 118\u2009mmol\/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual\/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>\n                      A pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.crd.york.ac.uk\/PROSPERO\">http:\/\/www.crd.york.ac.uk\/PROSPERO<\/jats:ext-link>\n                      (registration no. CRD42019129809).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-046539","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T11:42:24Z","timestamp":1639050144000},"page":"e046539","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review"],"prefix":"10.1136","volume":"11","author":[{"given":"Gopala K","family":"Rangan","sequence":"first","affiliation":[{"name":"Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia"},{"name":"Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, 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