Exertional Hyponatremia

by Patty Allen

Introduction

Overview Hyponatremia occurs when the concentration of sodium in the blood is abnormally low. Sodium is an electrolyte and helps regulate the amount of water in and around cells.
In most cases, exercise-induced hyponatremia is attributed to excessive consumption of free water, which fails to replenish the sometimes massive sodium losses from sweating. . The risk of hyponatremia can be reduced by strategies to ensure fluid balance during exercise by maintaining the appropriate volume and type of fluid intake.
Prevention. Getting treatment for conditions that contribute to hyponatremia, such as adrenal gland insufficiency, can help prevent low blood sodium levels. Find out. If you have a medical condition that increases the risk of hyponatremia or if you take diuretic medications, be aware of the signs and symptoms of low blood sodium.
When intake exceeds water loss by urine, sweat and blood loss. often greater than 1.5 litres), athletes may retain free water, leading to dilutional hyponatremia.

What is exogenous exercise-associated hyponatremia (EAH)?

Exercise-associated hyponatremia (EAH) is defined as a serum sodium level below 135 mmol/L that develops during or up to 24 hours after physical activity. [1][2] EAH was previously thought to occur only in extreme endurance athletes; however, its incidence is increasing in many athletes who experience a wide range of symptoms.
Consequently, athletes who develop EHA may exhibit defects in renal water excretion and/or significant sodium losses or an inability to mobilize exchangeable sodium stores. Additionally, some athletes develop hyponatremia without appreciable gains in total body weight (34). -associated hyponatremic encephalopathy (EAHE).
The authors estimated that athletes who gained >4% body weight during exercise had a 45% chance of developing hyponatremia. Importantly, 70% of people who gained weight during exercise did not develop hyponatremia, indicating other important factors in pathogenesis, as discussed below (34).

What causes exercise-induced hyponatremia?

In most cases, exercise-induced hyponatremia is attributable to excessive intake of free water, which fails to replenish the sometimes massive sodium losses resulting from sweating. The risk of hyponatremia can be reduced by strategies to ensure fluid balance during exercise by maintaining the appropriate volume and type of fluid intake.
After exercise, a symptomatic hyponatremic athlete will typically follow one of the two basic routes. Drink generous amounts The goal is to maintain Drink an adequate amount of fluids in the 24 hours prior to fluid balance. fluid to be replenished for exercise.
Hyponatremia is defined as a serum sodium concentration below 135 mEq/L, but may vary to some extent depending on the values established by various laboratories.[1] Hyponatremia is a common electrolyte abnormality caused by an excess of total body water relative to total body sodium content.
A common scenario for medical personnel working in endurance sports events is the care of thecollapsed athlete�. studies have examined the incidence of hyponatremia in this cohort, and a range of 6-30% of these athletes had serum sodium values below normal (9, 10, 12, 15-25).

How to prevent hyponatremia?

Prevention. Getting treatment for conditions that contribute to hyponatremia, such as adrenal gland insufficiency, can help prevent low blood sodium levels. Find out. If you have a medical condition that increases your risk of hyponatremia or if you take diuretic medications, be aware of the signs and symptoms of low blood sodium.
Sodium is an electrolyte and helps regulate blood amount of water in your blood. cells. In hyponatremia, one or more factors, ranging from an underlying medical condition to excessive water consumption, cause the sodium in your body to become diluted. When this happens, your body’s water levels increase,…
Check your serum sodium every 6 hours. Check serum sodium every 2 hours until corrected, then every 4 to 6 hours for the next 48 hours. Marjorie’s history indicates that she is susceptible to moderately symptomatic and severe chronic euvolemic hyponatremia, likely secondary to the use of a thiazide diuretic. when the dilution of the level of sodium in the blood is due to excessive alcohol consumption. This can be exacerbated by the loss of sodium in sweat during prolonged exercise. This variant of the disease is known asexercise-associated hyponatremia� or EAH.

What is dilution hyponatremia?

Dilution hyponatremia, also known as water intoxication, is a life-threatening condition that occurs when a person consumes too much water without adequate electrolyte intake. Simply put, body water must contain enough salts and other ions, called electrolytes, for body cells to function properly.
Sodium is an electrolyte and helps regulate the amount of water in and around cells. In hyponatremia, one or more factors, ranging from an underlying medical condition to excessive water consumption, cause the sodium in your body to become diluted. Cuando esto sucede, los niveles de agua de su cuerpo aumentan,…
Hiponatremia inducida por diur�ticos: La hiponatremia es com�n con el uso de tiazidas, comienza poco despu�s del inicio de las tiazidas, puede ser grave y es com�n en mujeres de advanced age. Thiazide-induced hyponatremia is due to increased water intake, decreased diluting capacity, and decreased distal tubular water excretion.
Hyponatremia. Diagnosis is based on measurement of serum sodium. Serum and urine electrolytes and assessment of osmolality and volume status help determine the cause. Treatment consists of restricting water intake and promoting water loss, replacing any sodium deficit, and correcting the underlying disorder.

How should a symptomatic hyponatremic athlete manage hydration during exercise?

We need to study larger cohorts of athletes to better characterize the risk of hyponatremia. Yet, current data warrant medical personnel considering hyponatremia as a possible cause of collapse during or after prolonged exercise. What is hyponatremia?
Before and during intense physical activity, athletes often overhydrate with hypotonic fluids (water, sports drinks). When intake exceeds water lost through urine, sweat, and insensible respiratory and gastrointestinal losses (often greater than 1.5 liters), athletes may retain free water, resulting in dilutional hyponatremia .
Sans However, some athletes survived hyponatremia <115 mmol/litre (Backer et al., 1993), while others died at >120 mmol/litre (Gardner, 2002a). Hyponatremia occurring in athletes is most often characterized by hypoosmolality (hypotonicity) of plasma. exercise. [1][2] EAH was previously thought to occur only in extreme endurance athletes; however, its incidence is increasing in many athletes who experience a wide range of symptoms.

What is the incidence of hyponatremia in endurance athletes?

The cause of exercise-induced hyponatremia in ultra-endurance athletes is currently unknown. Decreased total body sodium due to sweating or increased total body water secondary to ingestion of hypotonic fluids do not appear to be significant mechanisms.
cases exceeding 30% of athletes tested (O’Toole et al ., 1995).
Hyponatremia is a dangerous condition of low blood sodium concentration that can occur during exercise. Most cases of hyponatremia are due to excessive consumption of water and sports drinks during exercise, and are more common in athletes who take longer to complete endurance events. rates reported in athletes (Davis et al. 1999; O’Toole et al., 1995; Speedy et al., 1999). The wide disparity in incidence rates may partly reflect differences in case detection and severity.

What is the role of sodium in hyponatremia?

Sodium is an electrolyte and helps regulate the amount of water in and around cells. In hyponatremia, one or more factors, ranging from an underlying medical condition to excessive water consumption, cause the sodium in your body to become diluted. When this happens, your body’s water levels increase,…
When sodium intake and loss are out of balance, the total amount of sodium in the body is affected. The amount (concentration) of sodium in the blood may be too low ( hyponatremia Hyponatremia (low sodium level in the blood) In case of hyponatremia, the sodium level in the blood is too low.
Sodium is an essential electrolyte which helps maintain fluid balance in and around cells Important for the proper functioning of muscles and nerves Also helps maintain stable blood pressure levels Insufficiency of sodium in the blood is also known as hyponatremia Se produced when water and sodium are out of balance .
The amount (concentration) of sodium in the blood may be too low (hyponatremia Hyponatremia (low sodium level in the blood) In hyponatremia, the sodium level in the blood Low sodium has many causes, including excessive fluid intake, kidney failure, heart failure, cirrhosis, and diuretic use s…read more)

How often should sodium levels be checked in patients with hyponatremia?

Check serum sodium every 6 hours. Check serum sodium every 2 hours until corrected, then every 4 to 6 hours for the next 48 hours. Marjorie’s history indicates that she is susceptible to mildly symptomatic, severe chronic euvolemic hyponatremia, likely secondary to the use of a thiazide diuretic.
Hyponatremia is defined as a serum sodium concentration below 135 mEq /L, but may measure, based on established values from various labs.[1] Hyponatremia is a common electrolyte abnormality caused by an excess of total body water relative to total body sodium content. He or she may also suggest that you adjust your use of diuretics to increase the level of sodium in your blood.
Your body needs sodium for fluid balance, blood pressure control, as well as for nerves and muscles. Normal blood sodium levels are 135 to 145 milliequivalents/litre (mEq/L). Hyponatremia occurs when the sodium level in the blood falls below 135 mEq/L. When the sodium level in the blood is too low, excess water enters the cells and causes them to swell.

What is exercise-associated hyponatremia (EAH)?

Exercise-associated hyponatremia (EAH) is defined as a serum sodium level below 135 mmol/L that develops during or up to 24 hours after physical activity.
However, recent studies have shown that Endurance athletes frequently develop hyponatremia late in the race. , usually in the absence of clear central nervous system symptoms (9, 10, 12, 15�25). /7 mmol/L for those who gained little weight and 141.1 3.7 mmol/L for those who lost weight during the race. The authors estimated that athletes who gained >4% body weight during exercise had a 45% chance of developing hyponatremia.
The authors estimated that athletes who gained >4% body weight during exercise had 45% chance of developing hyponatremia. hyponatremia. Importantly, 70% of people who gained weight during exercise did not develop hyponatremia, indicating other important factors in pathogenesis, as discussed below (34).

Conclusion

Typonatremia is a well-known complication of diuretic administration that usually resolves upon discontinuation of the drug. Severe hyponatremia of levels below 115 mEq/L due to the use of diuretics is relatively rare. Thiazides appear to be more involved than loop diuretics.
Thiazides may be the sole cause and may exacerbate hyponatremia in patients with disorders causing the syndrome of inappropriate antidiuretic hormone secretion. Although thiazides do not inhibit… Shortly after their introduction in 1957, thiazide diuretics became a recognized cause of hyponatremia.
Hyponatremia is an occasional but potentially life-threatening complication of diuretic therapy. Virtually all cases of severe diuretic-induced hyponatremia have been due to a thiazide-type diuretic [1-7]. normal saline will not restore free water clearance or serum Na+ concentration. In these patients, hypertonic saline will predictably increase serum Na+ concentration and is preferable.

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