Siegel Arthur J
Department of Internal Medicine, McLean Hospital, Belmont, Massachusetts, USA.
Am J Med. 2006 Jul;119(7 Suppl 1):S74-8. doi: 10.1016/j.amjmed.2006.05.012.
Exercise-associated hyponatremia (EAH) has emerged in recent years as a life-threatening complication of endurance sports that may lead to fatal cerebral and pulmonary edema. Defined as a serum sodium concentration <135 mEq/L (1 mEq/L = 1 mmol/L), symptomatic EAH is a dilutional hyponatremia with abnormal fluid retention mediated by decreased urine production, which is a variant of the syndrome of inappropriate antidiuretic hormone secretion. Strategies for prevention and treatment must take into account the pathophysiology underlying this dominant clinical paradigm. Beyond educating runners to drink moderately, monitoring changes in body weight during endurance sports may facilitate the early detection of positive fluid balance characteristic of symptomatic cases. Rapid diagnosis by point-of-care testing indicates the need for fluid restriction in mild cases and emergent treatment with hypertonic (3%) NaCl to reverse acute hypotonic encephalopathy. The efficacy of arginine vasopressin V(2) receptor antagonists warrants study as an alternative treatment to loop diuretics for volume overload in these patients. Nonosmotic stimulation of arginine vasopressin secretion may be mediated in part by enhanced release of muscle-derived interleukin-6 during glycogen depletion, linking exertional rhabdomyolysis to the pathogenesis of EAH.
运动相关性低钠血症（EAH）近年来已成为耐力运动中一种危及生命的并发症，可能导致致命的脑和肺水肿。有症状的EAH定义为血清钠浓度<135 mEq/L（1 mEq/L = 1 mmol/L），是一种稀释性低钠血症，由尿量减少介导的异常液体潴留引起，是抗利尿激素分泌异常综合征的一种变体。预防和治疗策略必须考虑到这种主要临床模式的病理生理学。除了教育跑步者适度饮水外，在耐力运动期间监测体重变化可能有助于早期发现有症状病例的正水平衡特征。即时检测快速诊断表明，轻度病例需要限制液体摄入，而严重病例则需要用高渗（3%）氯化钠进行紧急治疗以逆转急性低渗性脑病。精氨酸加压素V2受体拮抗剂作为这些患者容量超负荷时袢利尿剂的替代治疗方法，其疗效值得研究。精氨酸加压素分泌的非渗透性刺激可能部分由糖原耗竭期间肌肉来源的白细胞介素-6释放增加介导，这将运动性横纹肌溶解与EAH的发病机制联系起来。
