Exercise-Associated Collapse: Is Hyponatremia in Our Head?

Exercise-associated hyponatremia (EAH) is one of the most common causes of exercise-associated collapse. The primary pathogenesis of EAH is largely the result of excessive fluid intake but is influenced by other factors, including hormonal abnormalities (ie, inappropriate arginine vasopressin secretion), renal abnormalities, and mobilization of sodium stores. Early recognition of EAH is crucial to appropriate treatment, because symptoms are varied and may be confused with other causes of exercise-associated collapse. Onsite testing of [Na+] will confirm the diagnosis but is not always available. Rapid treatment of EAH will depend upon the type and severity of symptoms. Treatment protocols range from fluid restriction or oral hypertonic fluids for mild symptoms to intravenous hypertonic fluids for more severe symptoms. Preventative strategies should emphasize fluid consumption based on thirst and athlete/coach/staff education regarding proper hydration practices.