Bennett Brad L, Hew-Butler Tamara, Rosner Mitchell H, Myers Thomas, Lipman Grant S
Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI.
Wilderness Environ Med. 2020 Mar;31(1):50-62. doi: 10.1016/j.wem.2019.11.003. Epub 2020 Feb 8.
Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol·L that occurs during or up to 24 h after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in environments in which medical care is limited and often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to increase the likelihood of a positive outcome. To mitigate the risk of EAH mismanagement, care providers in the prehospital and in hospital settings must differentiate from other causes that present with similar signs and symptoms. EAH most commonly has overlapping signs and symptoms with heat exhaustion and exertional heat stroke. Failure in this regard is a recognized cause of worsened morbidity and mortality. In an effort to produce best practice guidelines for EAH management, the Wilderness Medical Society convened an expert panel in May 2018. The panel was charged with updating the WMS Practice Guidelines for Treatment of Exercise-Associated Hyponatremia published in 2014 using evidence-based guidelines for the prevention, recognition, and treatment of EAH. Recommendations are made based on presenting with symptomatic EAH, particularly when point-of-care blood sodium testing is unavailable in the field. These recommendations are graded on the basis of the quality of supporting evidence and balanced between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.
运动相关性低钠血症（EAH）的定义为，在长时间体力活动期间或结束后24小时内，血清或血浆钠浓度低于135 mmol·L的正常参考范围。据报道，它发生在个体体育活动中，或在医疗条件有限且往往无法获得医疗服务的环境中进行的有组织耐力赛事期间，而且将患者转运至确定性治疗机构的时间往往会大幅延迟。对于严重形式的EAH，快速识别和适当治疗对于提高良好预后的可能性至关重要。为降低EAH管理不当的风险，院前和医院环境中的医护人员必须将其与具有相似体征和症状的其他病因区分开来。EAH最常见的情况是与热衰竭和劳力性热射病有重叠的体征和症状。在这方面的失误是导致发病率和死亡率恶化的一个公认原因。为制定EAH管理的最佳实践指南，荒野医学协会于2018年5月召集了一个专家小组。该小组负责使用基于证据的EAH预防、识别和治疗指南，更新2014年发布的荒野医学协会运动相关性低钠血症治疗实践指南。这些建议是基于有症状的EAH提出的，特别是在现场无法进行即时血钠检测的情况下。这些建议根据支持证据的质量进行分级，并根据美国胸科医师学会规定的方法，在每个参数的益处与风险/负担之间取得平衡。
