title: Exercise associated hyponatraemia leading to tonic-clonic seizure.
abstract: A 34-year-old Filipino lady presented to the emergency department with breathlessness and muscle cramping following a Bikram yoga workout. The patient reported sweating excessively while performing 90 min of strenuous exertion in a humidified room heated to an ambient temperature of 40.6°C. After the workout she drank 3.5 litres of water before experiencing breathlessness, severe muscle cramps, nausea and general malaise. Initial investigations revealed severe hyponatraemia (120 mmol/l). Despite early sodium replacement the patient dropped her Glasgow coma scale to 9/15 and developed tonic clonic seizures, requiring intubation and admission to the intensive care unit. The hyponatraemia was slowly corrected on the intensive care unit and the patient made a full recovery over the course of 5 days. This case highlights the dangers of overzealous fluid replacement following severe exertion in a hot environment.
authors.affiliation: Accident and Emergency Department, Chelsea and Westminster Hospital, London, UK. c.reynolds@nym.hush.com
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Reynolds
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Cleaver
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Finlay
mesh_terms: D000328:Adult; D004326:Drinking / Q000502:physiology; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology* / Q000503:physiopathology; D015444:Exercise / Q000502:physiology; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000503:physiopathology; D007362:Intensive Care Units; D035583:Rare Diseases; D013546:Sweating / Q000502:physiology; D015013:Yoga