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Exercise-associated hyponatremia: overzealous fluid consumption.
Wilderness Environ Med. 2009 Summer; 20(2):139-43.WE

Abstract

Exercise-associated hyponatremia is hyponatremia occurring during or up to 24 hours after prolonged exertion. In its more severe form, it manifests as cerebral and pulmonary edema. There have now been multiple reports of its occurring in a wilderness setting. It can now be considered the most important medical problem of endurance exercise. The Second International Exercise-Associated Hyponatremia Consensus Conference gives an up-to-date account of the nature and management of this disease. This article reviews key information from this conference and its statement. There is clear evidence that the primary cause of exercise-associated hyponatremia is fluid consumption in excess of that required to replace insensible losses. This is usually further complicated by the presence of inappropriate arginine vasopressin secretion, which decreases the ability to renally excrete the excess fluid consumed. Women, those of low body weight, and those taking nonsteroidal anti-inflammatory drugs are particularly at risk. When able to be biochemically diagnosed, severe exercise-associated hyponatremia is treated with hypertonic saline. In a wilderness setting, the key preventative intervention is moderate fluid consumption based on perceived need ("ad libitum") and not on a rigid rule. (Editor's Note: This paper was written at my request in an effort to increase awareness of this important clinical entity among members of the wilderness community, many of whom are involved in activities that place them at risk of its development. I thank the authors for their diligent efforts.)

Authors+Show Affiliations

Sir Charles Gairdner Hospital, Nedlands, Western Australia. ian.rogers@health.wa.gov.auNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19594207

Citation

Rogers, Ian R., and Tamara Hew-Butler. "Exercise-associated Hyponatremia: Overzealous Fluid Consumption." Wilderness & Environmental Medicine, vol. 20, no. 2, 2009, pp. 139-43.
Rogers IR, Hew-Butler T. Exercise-associated hyponatremia: overzealous fluid consumption. Wilderness Environ Med. 2009;20(2):139-43.
Rogers, I. R., & Hew-Butler, T. (2009). Exercise-associated hyponatremia: overzealous fluid consumption. Wilderness & Environmental Medicine, 20(2), 139-43. https://doi.org/10.1580/08-WEME-CON-231R2.1
Rogers IR, Hew-Butler T. Exercise-associated Hyponatremia: Overzealous Fluid Consumption. Wilderness Environ Med. 2009;20(2):139-43. PubMed PMID: 19594207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise-associated hyponatremia: overzealous fluid consumption. AU - Rogers,Ian R, AU - Hew-Butler,Tamara, PY - 2009/7/15/entrez PY - 2009/7/15/pubmed PY - 2009/9/26/medline SP - 139 EP - 43 JF - Wilderness & environmental medicine JO - Wilderness Environ Med VL - 20 IS - 2 N2 - Exercise-associated hyponatremia is hyponatremia occurring during or up to 24 hours after prolonged exertion. In its more severe form, it manifests as cerebral and pulmonary edema. There have now been multiple reports of its occurring in a wilderness setting. It can now be considered the most important medical problem of endurance exercise. The Second International Exercise-Associated Hyponatremia Consensus Conference gives an up-to-date account of the nature and management of this disease. This article reviews key information from this conference and its statement. There is clear evidence that the primary cause of exercise-associated hyponatremia is fluid consumption in excess of that required to replace insensible losses. This is usually further complicated by the presence of inappropriate arginine vasopressin secretion, which decreases the ability to renally excrete the excess fluid consumed. Women, those of low body weight, and those taking nonsteroidal anti-inflammatory drugs are particularly at risk. When able to be biochemically diagnosed, severe exercise-associated hyponatremia is treated with hypertonic saline. In a wilderness setting, the key preventative intervention is moderate fluid consumption based on perceived need ("ad libitum") and not on a rigid rule. (Editor's Note: This paper was written at my request in an effort to increase awareness of this important clinical entity among members of the wilderness community, many of whom are involved in activities that place them at risk of its development. I thank the authors for their diligent efforts.) SN - 1080-6032 UR - https://www.unboundmedicine.com/medline/citation/19594207/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/1080-6032-20-2-139 DB - PRIME DP - Unbound Medicine ER -