Jul 13, 2015
Symptoms, Not Sodium, Should Guide Hyponatremia Treatment

Athletes showing signs of acute hyponatremia should be treated based on the severity of their neurological symptoms instead of lab-measured blood sodium levels. This is the recommendation in a statement developed during the Third International Exercise-Induced Hyponatremia Consensus Development Conference and printed in the July 2015 issue of The Clinical Journal of Sports Medicine.

According to an article on Medscape.com, blood sodium level is critical information in detecting exercise-induced hyponatremia (EAH), but it may not always be available. Thus, the study recommends looking at the degree of neurological impairment to determine treatment.

The statement says:

“Any athlete with EAH associated with signs or symptoms of encephalopathy should be immediately treated with an IV bolus or infusion of (hypertonic saline) to acutely reduce brain edema, with additional IV boluses administered until there is clinical improvement. The dose and route of HTS administration should be based upon the severity of clinical symptoms and the available HTS formulations. Numerous case reports and case series have validated the efficacy and safety use of IV HTS administration in symptomatic EAH … without complication..”

The statement also says the goal of this treatment is to stabilize the athlete enough to transfer them to an advanced medical care facility.

Ideally, the athlete should be transported with knowledgeable event medical personnel able to maintain the same level of care en route and to ensure that the treatment is not interrupted for evaluation such as computerized tomography (CT) imaging of the brain or treatments that may worsen hyponatremia, such as administration of hypotonic fluids, lactated Ringer’s, or isotonic (normal) saline. The diagnosis of EAH or EAHE must be communicated to the receiving physician upon transfer of care.

Another recommendation is that athletes with mild EAH may be treated with oral or IV hypertonic solutions.

In contrast to athletes with severe EAH, those with mild symptoms may be discharged from onsite medical care once symptoms have resolved and spontaneous urination has occurred. Repeat measurement of [sodium] is generally not required unless the patient has persistent symptoms after the initial treatment.

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