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 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.
Siegel
Arthur J
AJ
McLean Hospital, Belmont, MA, USA.
d'Hemecourt
Pierre
P
Adner
Marvin M
MM
Shirey
Terry
T
Brown
Jeffrey L
JL
Lewandrowski
Kent B
KB
D001927:Brain Diseases / Q000097:blood / Q000209:etiology / Q000628:therapy; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000097:blood* / Q000628:therapy*; D007010:Hyponatremia / Q000097:blood* / Q000628:therapy*; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D012420:Running