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Patients had nausea, emesis, and obtundation. The mean (+/=SD) plasma sodium level was 121 +/= 3 mmol/L, and oxygen saturation was less than 70%. Electrocardiograms and echocardiograms were normal. Chest radiographs showed pulmonary edema with a normal heart. Creatine phosphokinase-MB bands, troponin levels, and pulmonary wedge pressure were not elevated. Scanning of the brain showed cerebral edema. All patients were intubated and mechanically ventilated. Treatment with intravenous NaCl, 514 mmol/L, increased plasma sodium levels by 10 mmol/L in 12 hours. Pulmonary and cerebral edema resolved as the sodium level increased. One patient had unsuspected hyponatremic encephalopathy and died of cardiopulmonary arrest caused by brainstem herniation. All six treated patients recovered and were well after 1 year of follow-up. In healthy marathon runners, noncardiogenic pulmonary edema can be associated with hyponatremic encephalopathy. The condition may be fatal if undiagnosed and can besuccessfully treated with hypertonic NaCl. |
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CAT scan,abnormal
cerebral edema
chest x-ray,abnormal
encephalopathy
hyponatremia
hyponatremic encephalopathy
marathon running
mortality
MRI,abnormal
nausea and vomiting
prognosis
pulmonary edema
sports medicine,neurology of
treatment of neurologic disorder
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