Case Study: Symptomatic Exercise-Associated Hyponatremia in an Endurance Runner Despite Sodium Supplementation
Martin D Hoffman1, Thomas M Myers
1Dept. of Physical Medicine and Rehabilitation, Dept. of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA.
Summary
Sodium supplementation does not prevent exercise-associated hyponatremia (EAH) from overhydration. Early recognition and hypertonic saline treatment can manage mild EAH effectively.
Area of Science:
- Sports Medicine
- Endocrinology
- Emergency Medicine
Background:
- Exercise-associated hyponatremia (EAH) is a risk during prolonged exercise.
- Overhydration is a primary cause of EAH.
- Sodium supplementation is often believed to prevent EAH.
Observation:
- A runner with a history of EAH consumed excessive water and sodium (>6,500 mg) during a 72-km run.
- Despite high sodium intake, the runner developed symptomatic EAH with a serum sodium of 122 mEq/L.
- Emergency services were required for the runner.
Findings:
- Oral sodium supplementation did not prevent symptomatic EAH in this case.
- Field treatment with oral hypertonic saline (800 mg sodium) improved hyponatremia.
- In-hospital treatment with isotonic fluids led to further improvement via aquaresis.
Implications:
- High sodium intake does not guarantee prevention of EAH.
- Early recognition and field management of mild EAH with hypertonic saline and fluid restriction are effective.
- Further education on EAH pathophysiology and management is needed.
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