Fatal child abuse by forced water intoxication

Background. Although water intoxication leading to brain damage is common i n children, fatal child abuse by forced water intoxication is virtually unk nown. Methods. During the prosecution of the homicide of an abused child by force d water intoxication, we reviewed all similar cases in the United States wh ere the perpetrators were found guilty of homicide. In 3 children punished by forced water intoxication who died, we evaluated: the types of child abu se, clinical presentation, electrolytes, blood gases, autopsy findings, and the fate of the perpetrators. Findings. Three children were forced to drink copious amounts of water (ove r 6 L). All had seizures, emesis, and coma, presenting to hospitals with hy poxemia (Po-2 = 44 +/- 8 mm Hg) and hyponatremia (plasma Na = 112 +/- 2 mmo l/L). Although all showed evidence of extensive physical abuse, the history of forced water intoxication was not revealed to medical personnel, thus n one of the 3 children were treated for their hyponatremia. All 3 patients d ied and at autopsy had cerebral edema and aspiration pneumonia. The perpetr ators of all three deaths by forced water intoxication were eventually trie d and convicted. Interpretation. Forced water intoxication is a new generally fatal syndrome of child abuse that occurs in children previously subjected to other types of physical abuse. Patients present with coma, hyponatraemia, and hypoxemi a of unknown etiology. If health providers were made aware of the associati on, the hyponatremia is potentially treatable.