Abstract
1729 HISTORY - LF, a 30 yo WF high level triathlete, presented to the finish line of an Olympic Distance Championship Triathlon disoriented and unable to ambulate further without assistance. She was immediately supported, but after several steps was unable to ambulate further. She was subsequently carried immediately to the finish line medical tent. Ambient Weather: Wet Bulb Globe Temperature 81 F.; Sunny skies with haze; minimal breeze. PHYSICAL EXAMINATION: Temp. (rectal) Deferred (agitation). HR: 150. R: 30, deep. BP 110/60. Skin was warm and moist (sweaty); Turgor: Fair. MS: Awake, confused, agitated; Oriented to person, season, month; Monosyllabic. Exercise Associated Collapse Exertional Hyperthermia Dehydration INITIAL TREATMENT & FOLLOW UP: Six-point ice packs; free-flow garden hose. Two liters of normal saline given intravenously. Mental status steadily improved; HR steadily normalized. Began to take oral fluids; eventually able to ambulate unassisted. Conversation lucid and appropriate. Voided clear yellow urine. LF, a resident physician, was discharged to the care of family and friends. Subsequent to release from the Medical Tent, LF returned home, continued with dry heaves, developed frequent watery diarrhea, remained fatigued, and did not void again. She proceeded to the Emergency Room after 3 hours. Persistent Dehydration Rhabdomyolysis Acute Renal Failure / Acute Tubular Necrosis (?)Hyponatremia (?)Bowel Ischemia TEST & RESULTS IN ER: LABS: WBC = 30.45 with Left Shift; Hgb 12.9; CPK 744; Na 142, K 3.9, Cl 111, CO2 20, BUN 20, Cr 1.7; UA: Yellow, Clear, SpG 1.020, pH 5.0, Keto 15; Myoglobin - NEG. CXR: Bibasilar atelectasis/infiltrate; B/L pleural effusions. WORKING DIAGNOSIS: Dehydration; Mycoplasma pneumonia. 10-12 L NS given in ER Azithromycin LAB FOLLOW UP: Legionella: Negative. Mycoplasma: Negative (CF 1:8). Exertional Heat Injury with Dehydration & Mild Acidosis. Viral vs Other Bacterial pneumonia vs Pulmonary Congestion (Fluid Overload) Other Potential Underlying / Precipitating Process(es) • Leptospirosis; Overtraining Syndrome; Anemia vs "Sports Anemia"
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