Drowning in the desert: Exercise-induced hyponatremia at the Grand Canyon

Shopes, Ellen

doi:10.1016/s0099-1767(97)90274-9

Cited by 18 publications

(11 citation statements)

References 7 publications

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“…The exact role of hypertonic saline in the treatment of exercise‐associated hyponatremia is unclear as the only published data on its use in the treatment of severe exercise‐associated hyponatremia are case reports 3,8,18,25,32,33,43 . Central nervous system manifestations of hyponatremia (mental confusion, convulsions and coma) require aggressive treatment, in both the emergency department and intensive care unit.…”

Section: Management Of Exercise‐related Hyponatremiamentioning

confidence: 99%

Exercise‐associated hyponatremia: A review

2001

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This paper reviews the extensive literature on hyponatremia, a common and potentially serious complication of ultra‐distance exercise. Fluid overload is the likely aetiology. Fluid intakes are typically high in athletes who develop hyponatremia, although hyponatremia can occur with relatively modest fluid intakes. The development of fluid overload and hyponatremia in the presence of a modest fluid intake raises the possibility that athletes with this condition may have an impaired renal capacity to excrete a fluid load. The bulk of evidence favours fluid retention in the extracellular space (dilutional hyponatremia) rather than fluid remaining unabsorbed in the intestine. Female gender is an important risk factor for the development of hyponatremia. Management and prevention of exercise‐associated hyponatremia are discussed. See Commentary, page 5.

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Section: Management Of Exercise‐related Hyponatremiamentioning

confidence: 99%

Exercise‐associated hyponatremia: A review

2001

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“…The autopsy revealed massive brain and pulmonary edema [120]. Several cases of hyponatraemia have also been reported in the Grand Canyon in recent years [181]. A case report described a woman collapsing in the Grand Canyon National Park after a five-hour hike tour during which she consumed large amounts of fluid.…”

Section: Female Sex As Risk Factor For Exercise-associated Hyponatmentioning

confidence: 99%

Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance–Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review

et al. 2019

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Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110–115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon–Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).

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“…Multiple cases and near fatalities have occurred in the Grand Canyon along trails that are easily accessible to both novice and experts alike. [20][21][22] Hyponatremia accounted for 19% of heatrelated illness from 2004 to 2009. 23 Failure to take precautions for heat and fluid replacement, misunderstanding of personal fluid requirements, and inadequate physical preparation for the outing are common causes.…”

Section: Exercise-associated Hyponatremiamentioning

confidence: 99%