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Clin J Sport Med. 2008 May;18(3):273-8. doi: 10.1097/JSM.0b013e31815eb0b5.

Hypernatremia and intravenous fluid resuscitation in collapsed ultramarathon runners.

Author information

1
Department of Human Biology, University of Cape Town, Cape Town, South Africa. tamara.hew@chw.edu

Abstract

OBJECTIVE:

To determine if a return to normonatremia is required for symptomatology to resolve in collapsed hypernatremic runners and if intravenous (IV) administration of an isotonic solution would adversely affect serum sodium concentration ([Na+]) in collapsed normonatremic runners.

DESIGN:

Observational study.

SETTING:

2006 Comrades Marathon.

PARTICIPANTS:

103 collapsed runners.

MAIN OUTCOME MEASURE:

Final serum [Na] upon discharge.

RESULTS:

58% of all collapsed runners were hypernatremic. Hypernatremic runners reported significantly more vomiting than normonatremic runners (79 versus 34%; P < 0.001). A significant decrease in serum [Na] in hypernatremic collapsed runners occurred after the IV administration of either 1 L of 0.45% normal saline (150.5 +/- 3.5 versus 148.0 +/- 4.6; P < 0.05) or Ringers lactate solution (147.7 +/- 2.2 versus 146.2 +/- 2.1; P < 0.05). One liter of IV fluid administration caused an increase in plasma volume that was not significantly different between (1) hypernatremic runners receiving a hypotonic solution (13.5 +/- 12.7%) and (2) normonatremic runners receiving an isotonic solution (15.6 +/- 11.3%). The final serum [Na+] of hypernatremic runners was above the range for normonatremia upon discharge (>145 mmol/L).

CONCLUSIONS:

A return to normonatremia was not required for hypernatremic runners to "recover" and be discharged from the medical tent. Vomiting either aggravated and/or facilitated the development of hypernatremia. IV administration of 1 L of either (1) a hypotonic solution to hypernatremic runners or (2) an isotonic solution to both normonatremic and hypernatremic runners did not produce any adverse biochemical or cardiovascular changes and can therefore be considered a safe and effective treatment for collapsed runners if used in this context.

PMID:
18469570
DOI:
10.1097/JSM.0b013e31815eb0b5
[Indexed for MEDLINE]

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