title: Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events.
abstract: Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness. Dehydration management with oral rehydration is generally adequate and preferred to intravenous rehydration, which should be reserved for athletes with sustained orthostasis or inability to tolerate oral fluid ingestion after some rest. In situations where intravenous hydration is initiated without known blood sodium concentration or hydration status, an intravenous concentrated sodium solution should be available in the event of acute neurological deterioration consistent with the development of EAH encephalopathy.
authors.affiliation: 1Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA; 2Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY; 3St. John of God Murdoch Hospital & University of Notre Dame, Murdoch, WA, Australia.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Hoffman
authors.forename: Jeremy
authors.initials: J
authors.lastname: Joslin
authors.forename: Ian R
authors.initials: IR
authors.lastname: Rogers
mesh_terms: D056352:Athletes; D003681:Dehydration / Q000517:prevention & control* / Q000628:therapy; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D014882:Water-Electrolyte Balance; D055814:Wilderness; D055813:Wilderness Medicine
chemical_list: D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic