Strange but true:drinking too much water can kill

喝水太多也會致死，過量喝水的隱患

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

在一個對喝水有狂熱目標(biāo)的文化環(huán)境中，人們會因喝水導(dǎo)致死亡

???? by coco ballantyne on june 21, 2007（由可可巴蘭在2007年6月21日所寫）

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.

水是生命的必要條件，在人體中占有66%，流經(jīng)血液，組成細(xì)胞并占據(jù)著細(xì)胞間隙。每時每刻水都要離開人體，通過呼氣，汗液，尿液，各種排遺物和各類途徑。補充這類流失的水分是必要的，但也有可能被過量進行。

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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年早些時候，加利福尼亞州一位28歲的女性在參加電視臺喝水直播大賽后死亡。比賽是由任天堂舉辦，比賽的獎品是一臺游戲機。（在當(dāng)時一臺游戲機是比較昂貴的，而任天堂的提供的獎品對于游戲愛好者有致命的吸引力）。在3小時內(nèi)喝完6升水后（2 L/h > 0.96 L/h，0.96這一數(shù)字是水中毒的臨界數(shù)值換算后得到），詹妮弗奇怪地嘔吐，回到家后還有嘔吐常見的后遺癥——頭疼，之后發(fā)生死亡，而死因就是所謂的“水中毒”。

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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勝枚舉，令人唏噓不已。2005年加利福尼亞州立大學(xué)一個叫Chico的兄弟會（兄弟會是存在于美國、加拿大等國家的一種社團組織，以狂野派對聞名，欺凌事件不絕，入會儀式甚至不時造成死亡事件）讓一個21歲的男性在做完多輪俯臥撐之后喝入大量的水，而地點在一個冰冷的地下室。另一個死亡事件是一個俱樂部成員在在服用搖頭丸之后（搖頭丸一般是指含有致幻型苯丙胺類興奮劑成分的片劑和丸劑。服用后主要表現(xiàn)為活動過度、搖頭扭腰、嗜舞、妄想、不知羞恥、性沖動及幻覺和暴力傾向，故俗稱為“搖頭丸”）長時間跳舞，大汗淋漓，未來得及補水就已死亡。極端性的補水在耐力運動員中較為普遍。2005年新英格蘭醫(yī)學(xué)期刊的一篇研究表明接近1/6的馬拉松運動員有不同水平的低鈉血癥，血液過度稀釋，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.

低鈉血癥，是拉丁語和希臘詞根混合而成，被翻譯為“血液低鹽”，從定量的角度來說，低鈉血癥意味著血鈉濃度低于135 m mol/L(大約是3.26 g/L)。而正常的血鈉濃度應(yīng)在135 m mol/L到145m mol/L之間。嚴(yán)重的低鈉血癥會導(dǎo)致水中毒，水中毒的常見癥狀包括頭痛，疲勞，惡心，嘔吐，尿頻和精神錯亂。

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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.

在人體中腎臟控制著水，鹽的含量（這從另一個角度表明賣腎行為對人體的巨大損害，賣腎以及其他器官是對生命極不負(fù)責(zé)任的行為）以及通過數(shù)萬個腎小管時的篩血功能。當(dāng)一個人在短時間喝入大量水，腎臟的篩血速率將會小于喝入水的速率，血液將會出現(xiàn)“洪水”（純質(zhì)水太多導(dǎo)致相對鹽含量下降）。出現(xiàn)洪水的地方的核心區(qū)域?qū)懈嗟柠}和溶質(zhì)，而多余的水會離開血液最終進入到細(xì)胞之中，使細(xì)胞腫脹來容納過多的水。

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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.

大多數(shù)細(xì)胞都有一定的空間（這空間是微觀概念，對于宏觀視角來講仍然是末如草芥）來伸展（大部分是控制細(xì)胞外液的含量穩(wěn)定），但對于大腦中的細(xì)胞——主要是“神經(jīng)元”

而言卻并非如此。（神經(jīng)元，下面都用腦細(xì)胞代替）腦細(xì)胞被緊緊固定在剛性骨籠里（所謂剛性就是物體保持形狀不變，外力過大就會毀壞物體的特性），就是頭顱骨，并且不得不將自己的空間也勻出一部分來使血液和腦脊液流動。杜克大學(xué)醫(yī)學(xué)中心臨床神經(jīng)學(xué)家沃爾夫?qū)ち械锰乜私忉尩溃?（杜克大學(xué)是世界頂級的研究性大學(xué)，美國南方最頂尖的高校，著名校友有蒂姆·庫克，梅琳達(dá)·蓋茨等）在腦顱之中幾乎沒有空間來脹大。

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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.

因此腦水腫或腦脹大，將是災(zāi)難性的?！笨焖俣謬?yán)重的低鈉血癥導(dǎo)致腦細(xì)胞水腫，進而導(dǎo)致腦積水，伴隨的癥狀是為癲癇（病狀表現(xiàn)為發(fā)作性運動、感覺、自主神經(jīng)、意識及精神障礙）發(fā)作，昏迷，呼吸停止，腦干受壓甚至是死亡”。穆罕默德·阿民·阿納歐特解釋，他是馬薩諸塞州中心醫(yī)院和哈佛醫(yī)學(xué)院腎臟學(xué)首席顧問。

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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."

那么人們是從哪里得到喝大量水是十分健康這一觀點的呢？許多年前達(dá)特茅斯醫(yī)學(xué)院（達(dá)特茅斯學(xué)院（Dartmouth College）成立于1769年12月13日，位于美國新罕布什爾州漢諾威鎮(zhèn)。達(dá)特茅斯是八所常春藤聯(lián)盟（Ivy League School）名校之一，也是建校早于美國建國的九所殖民地學(xué)院（Colonial Colleges）之一。）的一位腎臟學(xué)專家亨氏·瓦爾丁決定去確定尋常的建議——每天喝8杯8盎司（大約1.7L, 水中毒的臨界值是0.96L/h）是否能夠經(jīng)得起科學(xué)的驗證。在大量查閱同行文獻后，瓦爾丁得出結(jié)論：并沒有科學(xué)表明8ⅹ8的完美組合是正確的（對健康的生活在溫和環(huán)境中做溫和運動的人來講）。實際上喝的少或多對人體都有危害，這些行為都會在生理上潛在地形成低鈉血癥并且會加大人體內(nèi)部直接暴露在空氣中的風(fēng)險，在心理上人們也會因為沒有喝夠足量水而心生愧疚。瓦爾丁在他2002年對美國生理學(xué)雜志一篇文章——調(diào)節(jié)，綜合與比較生理學(xué)的評論中寫下。在出版他的發(fā)現(xiàn)后，瓦爾丁說“在行業(yè)中并沒有一篇論文已經(jīng)證明與我相反的結(jié)論”

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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.

大多數(shù)水中毒的情況并不僅僅只是因為短時間喝下大量水，約瑟夫·帕林利斯說。他是喬治敦大學(xué)醫(yī)學(xué)中心醫(yī)藥學(xué)主席（喬治敦大學(xué)，主校區(qū)在美國華盛頓特區(qū)白宮和國會大廈旁，是世界著名私立研究型大學(xué)，有歷史悠久的外交學(xué)院史，中國外交部現(xiàn)任部長王毅曾在此就讀。）約瑟夫解釋道“多數(shù)水中毒的原因往往是由于大量液體的攝入而造成的血管升壓素分泌增加，也就是抗利尿激素”（抗利尿激素是人體產(chǎn)生的激素，適量的作用效果會加強腎臟對原尿中純質(zhì)水的再吸收）抗利尿激素有下丘腦產(chǎn)生，之后通過神經(jīng)纖維運輸?shù)侥X垂體，再由腦垂體釋放后作用于腎臟而加強其保水作用?？估蚣に丶訌姳Ｋ饔玫臋C理在身體壓力期比較顯著（也就是在運動期間），特別是馬拉松。而在這段時間即使喝入大量水，人體也會大量保存下來，進而造成身體普遍性的積水。

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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.

健康的腎臟每小時可以排出800ml到1000ml的水，按照這樣粗略計算，不難得出一個人以800ml/h到1000ml/h的速率將不會有水的盈余，帕林利斯解釋道。如果同樣一個人正在跑馬拉松，下丘腦產(chǎn)生抗利尿激素的水平會上升，這將減弱腎臟的排出能力至少100ml/h。在這些情況之下，仍然保持這樣的速率喝水將會導(dǎo)致水富足，有可能伴隨有大量汗液涌出。（從某種意義來講，吃飯?zhí)煲矔骱?，尤其是在使用水含量豐富的食物）

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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."因此在鍛煉時，你應(yīng)該平衡的并不是自己逼迫下的想法，而是尊重事實，尊重科學(xué)，平衡汗液與攝入水的量。運動時攝入的也自然包括運動飲料，當(dāng)然即使是運動飲料，過量攝入也有低鈉血癥誘發(fā)的風(fēng)險，而這些更適合每小時流汗500ml的人，并非是在跑一圈之后平靜如水的你。

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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."

我們聊了那么多，但實際上去實現(xiàn)卻并不容易。比如說，如何去測定馬拉松跑者，或任何一個人有多少水被排出？可能會有方法，但在實現(xiàn)之前，職業(yè)運動員將會更尊重自己的感覺。對于我們來講，只要你是健康的，只要你有一個沒有被年齡或精神類藥物所侵蝕的渴覺中樞，那么就在你稍微口渴時喝水。這就是最好的建議，而不是8ⅹ8喝水決定論

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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.

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??最后補充幾點:

一. ?按《中國居民膳食指南2016》的建議：每人每天應(yīng)飲水1500~1700ml。根據(jù)我們?nèi)粘Ｊ褂玫谋尤萘繐Q算，也就是我們常說的“8杯水”。

但是，并非每天都要喝8杯水，我們需要根據(jù)自己的飲食習(xí)慣，環(huán)境，出汗等情況來調(diào)整：

如運動量大，大量出汗，則需多喝水

在日常飲食中，如蔬菜、水果等攝入了足夠的水，那么就不必一定要喝8杯。

總而言之，對于大多數(shù)健康人來說，喝多少水這個問題，不要糾結(jié)8杯水，根據(jù)自己的情況個性化調(diào)整，想喝就喝，別總是不喝就是了。

一些患有腎病、心臟病、肝病的病人，需要遵從醫(yī)生的指示來限制他們的飲水量。

二.杯子的含量是不一樣的，所以僅僅通過八杯水來衡量喝水問題是片面無知的，因為從某種意義來講水是有毒的。我們更應(yīng)該是去尊重自己的真實感覺，而非一個別人的凌駕的“智論”。

三.對于人體喝水最大值的計算中，我們忽略睡覺的8個小時，按照16小時計算。那么總量是0.96L/h*16h=15.36L。這是非?？鋸埖臄?shù)值，也就是在平衡腎臟利尿速率，人體的調(diào)節(jié)能力非常強，但這是建立在時刻以16ml/h的速率喝水，顯然這又是不科學(xué)的。那么討論以容器含量為被除數(shù)的除法運算，以500ml來講，（500ml）/（16ml/min）=31.25min，但是這也會導(dǎo)致有將近500ml的尿量會在半小時內(nèi)被排出。而這又太頻繁，不妨擴大1.5倍，也就是兩小時內(nèi)喝完一杯水，并排尿一次是比較科學(xué)而合理的。

四.水中毒 的發(fā)生是由于人體腎臟的持續(xù)最大利尿速度是每分鐘16毫升，一旦攝取水分的速度超過了這個標(biāo)準(zhǔn)，過剩的水分會使細(xì)胞膨脹，引起 脫水 低鈉癥，一般會導(dǎo)致 頭暈 眼花、 嘔吐 、心跳加快等癥狀，嚴(yán)重的會出現(xiàn)痙攣、昏迷甚至危及生命。

五.保持人體的生理舒適度就是最健康的狀態(tài)，并非滿足一個遙不可及的幻想。

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