POST GAME COLLAPSE - FEMALE FOOTBALL PLAYER

Abstract

HISTORY A 30-year-old professional women's football player presented to the emergency room with altered mental status, headaches, nausea, and vomiting two hours after completing a scheduled morning game. The game time temperature was 92 degrees Fahrenheit with 62 percent humidity. Immediately after the game the patient complained of headaches and “not feeling right”. She denied sustaining a head injury or physical injury during the game. Believing that she was dehydrated after the game, the patient recalls drinking abundant amounts of water in an attempt to “re-hydrate”. The patient reports drinking 30 – 40 ounces of water the night before the game, and 30 – 40 ounces during the game. Medications taken the morning of the game included ibuprofen, glucosamine, and a multivitamin. Her menstrual cycle had begun the day before. While in the emergency room the patient developed sinus bradycardia, became unresponsive, and went into respiratory distress requiring intubation. PHYSICAL EXAMINATION Pre-game wt 71 kg, ht 173 cm. Brief training room exam. Vitals not recorded. No clinical orthostasis. Gen: Alert and oriented. Tolerating oral intake. HEENT: Normal, no photophobia. Moist mucous membranes. Pulm/CV: Normal. Neuro/Musc: Normal mental status. Normal strength and tone. DIFFERENTIAL DIAGNOSIS Heat stroke/dehydration Electrolyte imbalance – hyponatremia, hypoglycemia, hypercalcemia Occult head injury Drug or alcohol intoxication Pneumothorax or Pulmonary embolism TESTS AND RESULTS Abnormal serum labs only: Na 117 meq/l (normal 135 – 145 meq/l), K 3.3 meq/l, Cl 87 meq/l, CO2 19 meq/l, Gl 169 mg/dl, Ca 8.0 mg/dl, WBC 154,000 units, Hgb 11.9 g/dl. Urine toxicology – negative. Urine HCG – negative. CT scan of the head was normal. Chest X-ray prior to intubation was without infiltrates or evidence of pulmonary edema. Upon correction of the patient's hyponatremia, the patient became increasingly responsive and was extubated three days later. The patient was without neurological sequelae following extubation and without evidence of permanent metabolic abnormalities. FINAL/WORKING DIAGNOSIS Acute severe hyponatremia – exercise associated TREATMENT AND OUTCOMES The patient received intravenous fluids of 0.9 percent normal saline, 3 percent normal saline, and lasix in order to correct her hyponatremia. ICU admission for four days. Extubated on third day. Repeat laboratory values two weeks after discharge were within normal limits. Returned to training one month after discharge. Returned to play in Women's Professional Football League (WPFL) playoffs. Education on appropriate fluid replacement practices.