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Exercise-Associated Hyponatremia, Sports Medicine

Michael K. Seifert, MD, CAQSM and William W. Dexter, MD, FACSM Reviewed 04/2019
 


BASICS

DESCRIPTION

  • Decrease in serum sodium concentration to <135 mmol/L during or up to 24 hr after physical activity

  • Serum sodium concentration and serum osmolarity are maintained by homeostatic me...

DIAGNOSIS

HISTORY

  • Thorough past medical, surgical, and social history

  • Ask about previous episodes of sodium problems or postrace medical issues.

  • Attempt to estimate water and food intake during race.

  • Inqu...

TREATMENT

GENERAL MEASURES

  • Airway, breathing, and circulation (ABC)

  • Obtain rectal temperature 3[C].

  • Consider establishing intravenous (IV) access.

  • Place patient in supine position, elevate legs to increas...

ONGOING CARE

PROGNOSIS

  • Mild hyponatremia will almost always correct with autodiuresis and have no long-term consequences.

  • An episode of exercise-associated hyponatremia may indicate an increase suscepti...

REFERENCES

1
Urso C, Brucculeri S, Caimi G. Physiopathological, epidemiological, clinical and therapeutic aspects of exercise-associated hyponatremia. J Clin Med.  2014;3(4):1258–1275.
2
Hew-Butler ...

ADDITIONAL READING

  • Bennett BL, Hew-Butler T, Hoffman MD, et al. Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia: 2014 update. Wilderness Environ Med. ...

CLINICAL PEARLS

  • Exercise-associated hyponatremia is common in long-distance and endurance events.

  • Most cases are asymptomatic.

  • Excessive fluid intake beyond what is required by thirst is the primary mec...

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