Use of Hypertonic Saline in the Treatment of Exercise-associated Hyponatremia: Setting the Record Straight

Abstract

The use of hypertonic saline in symptomatic exercise-associated hyponatremia (EAH) is a topic of great debate. Many unnecessary deaths from this condition have occurred because of failure of many in the exercise community to understand the proper use of this life-saving therapy. Dr. Ayus's group have been the pioneers in the use of hypertonic saline in the treatment of EAH. A landmark paper appearing in the Annals of Internal Medicine (2000) originally outlined its use in marathon runners with EAH presenting with non-cardiogenic pulmonary edema.1 They systematically used hypertonic saline to treat six runners with hyponatremic encephalopathy. His group went on to introduce the novel concept of using a 100 cc bolus of 3% NaCl for this condition2,3 and he was the first in the world to treat EAH this way in 2005 in a marathon in Cape Town, South Africa.4 In our recent paper,5 it appears that credit has not been given fully to Dr. Ayus and his colleagues. It is imperative that recognition be given to those who have done the original work and it is our hope that this sets the record straight. Tamara Hew-Butler, DPM, PhD Systematic Inflammation Laboratory Phoenix, AZ Timothy D. Noakes, MB ChB, MD, DSc University of Cape Town Cape Town, South Africa Arthur J. Siegel, MD Harvard Medical School Boston, MA