Chemistry - Effect of drinking ultra-pure water

Solution 1:

What would be the effect if someone were to drink ultra-pure, 18 M-ohm water?

Not much, although if they drank many gallons of the water it could be a problem.

Would they immediately die?

No.

Would they just need to pee more?

Probably.

Would $\ce{CO2}$ from the air (after the bottle is opened) and whatever's in saliva dissolve into the water making it much less pure before it gets into the important parts of their digestive tract?

It would become orders of magnitude less pure as soon as it mixed with their saliva and then their gastric juices. Same as regular water.

What would be the threshold for bad things to happen -- a teaspoon, a liter, 12 gallons in 10 minutes (at which point I assume regular water would kill you)?

I don't think the effect would be that different from drinking regular water. All over the internet there is this idea that super pure water is somehow too pure or dangerous, no good evidence or mechanism is ever presented.

Water is toxic primarily because it dilutes the sodium and potassium ions in your body, leading to Hyponatremia or possibly the far more dangerous Hypokalemia. The normal level of $\ce{Na+}$ in blood plasma is about 135 millimolar (mM), and the normal level of $\ce{K+}$ is about 5 mM.

A very rough approximation to understanding how toxic water can be would then be to compare the concentration difference of sodium (or potassium) between the ingested water and the blood. A 25 micromolar -- i.e. 25 μM or 0.000025 molar solution of sodium hydroxide has a conductivity of about 6.7 microsiemens per cm, more than 100-fold higher than "pure" 18.2 megohm water (0.055 microsiemens per cm). According to this rough difference-based model, the ability of the very dilute sodium ion solution to cause problems is proportional to (135 - 0.025) mM, and the ability of the "pure" water to cause problems is (135 - 0) mM. For nearly biological or medical conditions of interest, 135 mM is not really different from 134.975 mM, and so ultra-pure water is not really more dangerous than everyday drinking water.

Solution 2:

Pure water (i.e. 18 Megohm conductivity) is still just water. If you don't drink so much as to cause water intoxication, it would be no different physiologically from drinking tap water or bottled water.