Fatal hyponatremia by massive ingestion of water to commit suicide

Hyponatremia (blood sodium level <136 mmol/L) is common in routine medical practice and is usually quickly resolved. Symptoms include headaches and edema. In the most severe cases, it can lead to neurological disorders and even death. A 33-year-old woman, who had been hospitalized for 15 days after attempting suicide with medication, was found unconscious by the nursing staff. The biological work-up carried out in the intensive care unit revealed severe hyponatremia (113 mmol/L). Toxicology was negative. Cerebral CT scan showed severe diffuse cerebral edema. The autopsy performed the day after death revealed massive fluid overload. During the police investigation, we confirmed that the cause of death was severe hyponatremia resulting from massive ingestion of water and the manner of death was determined to be suicide. Deliberate water intoxication is a rare form of suicide and should be considered in cases of sudden onset of unconsciousness in a suicidal patient.