Hypernatremia and Intravenous Fluid Resuscitation in Collapsed Ultramarathon Runners

Abstract

A return to normonatremia was not required for hypernatremic runners to "recover" and be discharged from the medical tent. Vomiting either aggravated and/or facilitated the development of hypernatremia. IV administration of 1 L of either (1) a hypotonic solution to hypernatremic runners or (2) an isotonic solution to both normonatremic and hypernatremic runners did not produce any adverse biochemical or cardiovascular changes and can therefore be considered a safe and effective treatment for collapsed runners if used in this context.

Statement of the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015

“…EAH must be differentiated from other causes of collapse that may present with similar signs and symptoms including exertional heat illness,73 acute mountain sickness,39 hypernatraemia149 150 and exercise-associated postural hypotension 148. It is important for medical staff to perform a rapid history and physical examination to help determine the aetiology of these non-specific symptoms.…”

“…For example, an education programme for an Ironman triathlon advising athletes of the risks incurred by overdrinking, coupled with decreasing the number of fluid stations to limit the fluid availability, reduced the incidence of EAH 178–180. Dissemination of appropriate drinking advice alone has also been shown to reduce the incidence of EAH in a 90 km footrace 150 181…”

Study of Injury and Illness Rates in Multiday Ultramarathon Runners

“…These previous studies did not report skin or medieal illness rates. Several studies have reported an 8%-5O% incidence of hyponatremia (11,16), 2%-4% prevalence of hyponatremia (11,12,24,25,28), and 45%-58% of hypematremia (11,12) in collapsed ultramarathon runners. Studies of marathon rurmers have reported an overall injury/illness rate of 18.9-25.5 per 1000 runners, medieal illness rates of 10.1-13.7 per 1000 runners, MSK injury rate of 3.35 per 1000 runners, and skin injury rate of 4.1 per 1000 runners (2,9,23,26,29).…”

The Secret Stories of Sodium How Infants, Athletes, Psychotics, And Otherwise Healthy People Die from Sodium Imbalance

“…not excreted in urine) and increases the palatability of sodium-rich foods. 1,9 Sodium conservation and subsequent ingestion of salt alone or in combination serves to increase circulating plasma volume back to baseline levels over time (19)(20)(21)(22)(23)(24) hours), 10,11 while maintaining plasma tonicity through integrated coordination with the osmoregulatory system. 10 Hyponatremia: water intoxication vs. sodium loss When the sodium content (in millimoles) in relationship to a liter of plasma water is below 135 mmol/L (for most laboratories), a diagnosis of hyponatremia is biochemically confirmed, regardless of the presence or absence of clinical signs and symptoms.…”

“…Dire complications associated with hypernatremia include subarachnoid bleeding and hemorrhage due to tissue shrinkage and/or ischemia due to dehydration. 18,19 Babies with difficulties breastfeeding 20 or accidental salt poisoning, 21 athletes who do not drink enough water during exercise 22 or report vomiting during long races, 23 depressed individuals who intentionally ingest large amounts of salt, 24 and nursing home or hospitalized patients who are not given adequate amounts of fluids 25 have all become severely ill or died tragically from hypernatremia. Of note, most of these reported cases were complicated by: significant gastrointestinal losses; the absence of available hypotonic fluids; human error (mistaking salt for sugar), or psychiatric disorders (i.e.…”