Hew-Butler Tamara, Hamilton Rus, Hamilton Bridget, Colesa Zachary
1Exercise Science, Oakland University, Rochester, MI; 2Men's Health Melbourne, Melbourne, AUSTRALIA; and 3Department of Nursing, University of Melbourne, Melbourne, AUSTRALIA.
Curr Sports Med Rep. 2017 Jul/Aug;16(4):289-293. doi: 10.1249/JSR.0000000000000380.
Severe exercise-associated hyponatremia (EAH) is largely dilutional, whereas contributions of sodium loss remain equivocal. We present a case of EAH with encephalopathy involving an experienced male cyclist with no recollection of the event. We thereby conducted a retrospective analysis of biochemical trajectories during hospital recovery. The normalization of serum [Na], in context with changes in other variables, offered a 'reverse' perspective of the underlying pathophysiology. The following biochemical changes were temporally observed, with the return of normonatremia: 1) a decrease in serum potassium and calcium concentrations (absence of extracellular fluid dilution); 2) a decrease in total protein, blood urea nitrogen, hematocrit and hemoglobin (plasma volume expansion); and 3) an increase in mean platelet and red cell corpuscular volumes (cellular expansion after total body water and sodium deficits). Collectively, these temporal changes provide biochemical evidence suggesting that this patient's severe symptomatic EAH was associated with volume depletion from underreplaced sodium losses.
严重运动相关性低钠血症（EAH）主要是稀释性的，而钠丢失的影响仍不明确。我们报告一例伴有脑病的EAH病例，患者为一名经验丰富的男性自行车运动员，对该事件毫无记忆。因此，我们对其住院康复期间的生化指标变化轨迹进行了回顾性分析。血清[Na]的恢复正常，结合其他变量的变化，为潜在病理生理学提供了一个“反向”视角。在恢复正常血钠水平的过程中，观察到以下生化变化：1）血清钾和钙浓度降低（不存在细胞外液稀释）；2）总蛋白、血尿素氮、血细胞比容和血红蛋白降低（血浆容量扩张）；3）平均血小板体积和红细胞体积增加（全身水和钠缺乏后的细胞扩张）。总体而言，这些随时间变化的指标提供了生化证据，表明该患者严重的症状性EAH与钠补充不足导致的容量耗竭有关。
