title: Fatal water intoxication of an Army trainee during urine drug testing.
abstract: An Army trainee developed acute water intoxication, hyponatremia, pulmonary edema, and fatal cerebral edema. This is the first report of a fatality related to urine drug testing. This resulted from supervised excessive water ingestion in an attempt to induce a sufficient urine specimen for substance abuse testing. To avoid a similar preventable death in the future, we make several recommendations. These include limiting the volume of ingested fluid to eight ounces every 30 to 45 minutes, not to exceed 40 ounces, and providing a relaxed, reassuring environment when obtaining urine specimens for substance abuse detection.
authors.affiliation: Office of the Armed Forces Medical Examiner, Armed Forces Institute of Pathology, Rockville, MD 20850, USA.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Gutmann
authors.forename: John W
authors.initials: JW
authors.lastname: Gardner
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004326:Drinking; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011654:Pulmonary Edema / Q000209:etiology; D013048:Specimen Handling; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*; D013997:Time Factors; D014556:Urine; D014869:Water Intoxication / Q000150:complications*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine