Exertional Dysnatremia in Collapsed Marathon Runners: A Critical Role for Point-of-Care Testing to Guide Appropriate Therapy

Dysnatremia may cause life-threatening encephalopathy in marathon runners. Hypernatremia and exercise-associated hyponatremia (EAH) may manifest with mental status changes and, if untreated, progress to coma and death. We reviewed the on-site blood sodium testing and treatment in collapsed runners a...

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Bibliographic Details
Published in:American journal of clinical pathology 2009-09, Vol.132 (3), p.336-340
Main Authors: SIEGEL, Arthur J, D'HEMECOURT, Pierre, ADNER, Marvin M, SHIREY, Terry, BROWN, Jeffrey L, LEWANDROWSKI, Kent B
Format: Article
Language:English
Subjects:
Biological and medical sciences
Brain Diseases - blood
Brain Diseases - etiology
Brain Diseases - therapy
Fluid Therapy - methods
Humans
Hypernatremia - blood
Hypernatremia - therapy
Hyponatremia - blood
Hyponatremia - therapy
Investigative techniques, diagnostic techniques (general aspects)
Medical sciences
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Point-of-Care Systems
Practice Guidelines as Topic
Running
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Summary:Dysnatremia may cause life-threatening encephalopathy in marathon runners. Hypernatremia and exercise-associated hyponatremia (EAH) may manifest with mental status changes and, if untreated, progress to coma and death. We reviewed the on-site blood sodium testing and treatment in collapsed runners at the finish-line medical tent at the Boston marathons from 2001 through 2008. Dysnatremia was diagnosed in 429 (32.5%) of 1,319 collapsed runners. Hypernatremia was present in 366 (27.7%) and hyponatremia in 63 (4.8%). Hypernatremic runners unable to drink fluids were treated with intravenous normal (0.9%) saline. Hyponatremic runners with seizures or coma received intravenous hypertonic (3%) saline. Sixteen runners with EAH able to drink a concentrated oral hypertonic solution recovered within 30 minutes. Based on on-site sodium testing, dysnatremic runners were treated with appropriate intravenous fluids according to validated standards of care. Hyponatremic runners able to drink an oral hypertonic solution recovered promptly.
ISSN:0002-9173
1943-7722
DOI:10.1309/AJCP30OGLSLWLEIY