Management

Seek expert advice.

Urgent Na+ estimation

Urgent treatment is required when EAH is biochemically confirmed and there are signs of hyponatremic encephalopathy

• should be immediately treated with a bolus infusion of 100 mL of 3% NaCl to acutely reduce brain oedema. Up to two additional 100ml 3% NaCl bolus infusions should be given at 10 minute intervals if there is no clinical improvement (1)

Rapid administration of iv sodium does not carry risk of osmotic demyelination known to occur when this therapy is used in chronic hyponatremia.

In the absence of a Na+ measurement hypertonic saline cannot be recommended.

EAH may be worsened by the use of 0.9% NaCl (normal saline).

If EAH suspected on clinical grounds but Na+ not available iv fluids can only be justified to treat frank hypovolaemia.Witholding iv fluids may be life saving

If EAH confirmed or suspected evacuation to definite care is priority

Contributors (September 2010):

• Dr Volker Scheer (GP Locum), Dr Andrew Murray (Marathon Medical Services)

Reference:

• 1) Hew-Butler T, Ayus JC, Kipps C, Maughan RJ, Mettler S, Meeuwisse WH, Page AJ, Reid SA, Rehrer NJ, Roberts WO, Rogers IR, Rosner MH, Siegel AJ, Speedy DB, Stuempfle KJ, Verbalis JG, Weschler LB, Wharam P.Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference, New Zealand, 2007. Clin J Sport Med. 2008 Mar;18(2):111-21