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Blog post:
HypoNAtremia = Life Threat
Date:
this blog came out some time before year 2017. A facebook blog app
ceased to function, and MEDIC's back-up captured the content but not the date of
writing.
"Hypo" = too little, "Na" = the element symbol for Sodium. Drink too
much water without salt intake, risk death. Exercise exacerbates as you sweat
and lose salt. The following sad story tells of a Grand Canyon hiker who
did all of the above, and died. The story does a nice job of explaining what is
hyponatremia.
PREVENT: Drink to thirst -- not more, not less -- and make sure you're
taking in electrolytes at the same time. You *can* get hyponatremia if you
massively over-imbibe water even with electrolytes -- so again, drink to thirst
(with electrolytes).
Source of article that follows
~ ~ ~ ~ ~
"Grand Canyon Hiker Dies From Water Intoxication — What Can We Learn From Her
Death?
Oct 4, 2015 02:40 PM By Ed Cara
Even for something as essential as water, there really can be too much of a good
thing — that's the lesson that Dr. Thomas Myers and Dr. Martin Hoffman want
people to take to heart.
In this month's Wilderness & Environmental Medicine, the pair have detailed the
case study of an otherwise perfectly fit woman who died from water intoxication
after a five-hour-long hike at the Grand Canyon National Park in 2008. As they
explain, her death may represent the first reported "fatality due to acute
hyponatremia (low sodium in the blood) associated with hiking in a wilderness
setting." And they're hoping that it remains the last.
According to their report, the healthy 47-year-old British woman from London
spent the morning hiking 6 miles across the South Kaibab Trail in Grand Canyon
National Park on a clear and sunny September day with her husband. No sooner
than an hour after their hike ended at 1 p.m., the woman fainted but quickly
recovered, prompting emergency medical service (EMS) responders to take her to
the nearest hospital. Sluggish and complaining of a headache, the worst was
unfortunately yet to come for the woman.
At approximately 2:30 p.m., while the responders were arranging to transport
her, “she abruptly sat upright, pulling out her IV line in the process. She then
vomited a large amount of clear fluid and immediately became unresponsive,” the
authors wrote. Though hospital staff would stabilize her physical condition
eventually, the woman never woke up again, having become brain dead. She was
pronounced fully dead the next morning, less than 19 hours after she fainted.
Her brain had swelled to the point where blood flow had stopped entirely, a
condition known as cerebral edema.
According to her husband, the woman “drank a large amount of water and ate very
little” during the hike. The high level of water consumption, coupled with her
strenuous physical activity, had forced her body’s levels of blood sodium to
swing dramatically low, causing exercise-associated hyponatremia (EAH).
Long bouts of exercise, mainly through the act of sweating, can make the body
lose sodium, but it also causes the body to retain excess amounts of fluid. That
perfect storm can lead to the body becoming hypotonic, such that our cells
contain more sodium than the surrounding blood outside. Water then rushes into
the cells in a desperate and ultimately self-destructive act to restore balance.
Without proper treatment, these bloated cells wreak havoc across the body and
brain, clogging up the infrastructure of our bloodstream like a stopped pipe
that eventually bursts and floods the basement, only with far more lasting side
effects like coma, seizure, and death.
Though certainly rare, EAH is known to happen among marathon runners and other
endurance sports enthusiasts, with the authors noting that hikers had previously
been theorized to be at risk of it as well — a risk tragically confirmed.
Yet the woman’s death might have been preventable, they concluded. Had she been
immediately given a hypertonic IV solution that diverted water away from her
cells, instead of the standard (isotonic) saline treatment intended for
dehydration, which may have only worsened her condition, things could have
turned out differently.
Similarly, if EMS had had the opportunity to test her sodium levels prior to her
arrival at the hospital almost three hours later, they may have been able to
diagnose EAH much earlier. Even there, though, her tested sodium levels may not
have been considered low enough to conclude EAH, a mistake that “should serve as
further evidence that treatment should be based on the extent of symptoms rather
than the absolute sodium concentration,” the authors cautioned.
They added: “It is likely that symptom severity is related more to the rapidity
at which the serum sodium changes than to the absolute value.”
In the wake of the hiker’s death, the Grand Canyon National Park has implemented
changes to their emergency care, including the stocking of hypertonic IV fluids
and immediate blood sodium testing, strategies the authors advise any
establishment or sporting event that regularly deals with endurance athletes to
adopt (though water intoxication is only one of the unique problems that
marathon runners have to deal with).
“We hope that this report of a fatal outcome from EAH and the discussion about
the importance of rapid recognition and treatment will stimulate others to
develop more appropriate systems for the recognition and treatment of EAH,” they
concluded.
In the meantime, it seems that taking an extra nibble or two more during a long
hike may go a long way.
Source: Myers T, Hoffman M. Hiker Fatality From Severe Hyponatremia in Grand
Canyon National Park. Wilderness & Environmental Medicine. 2015."
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