在大峡谷徒步旅行时运动引起的低钠血症脑病、横纹肌溶解症和急性肾损伤。

IF 1.4 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Wilderness & Environmental Medicine Pub Date : 2024-12-01 Epub Date: 2024-10-24 DOI:10.1177/10806032241286487
Thomas M Myers, Brad L Bennett, Weston Myers
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引用次数: 0

摘要

我们介绍了一例在大峡谷徒步旅行者中同时发生运动相关性低钠血症脑病(EAHE)、劳累性横纹肌溶解症(ER)和急性肾损伤(AKI)的罕见病例。我们的病例患者是一名 41 岁的成年男性,他在炎热天气下山进入峡谷时饮用了过量的水。第二天,他因腿部剧痛和迷失方向而无法徒步离开,最终乘坐直升机撤离,并在飞行途中癫痫大发作。尽管他的血清钠含量不达标,但医护人员还是为他静脉注射了 3% 的高渗盐水 (HTS),然后将他送往医院。在医院,他被诊断为 EAHE(血清钠为 114 mmol⋅L-1)、急诊室、双侧隔室综合征和轻度 AKI。对危及生命的 EAHE 立即进行了更多的静脉注射 HTS,对危及肢体的室间隔综合征进行了外科筋膜切开术,最终通过口服和静脉输液纠正了 AKI。这个病例说明了过度饮水的严重性,以及体能下降的人在进行长时间剧烈运动时肌肉损伤的潜在并发症。此外,它还说明了在鉴别诊断急性意识水平改变时考虑 EAHE 的重要性。最后,它还说明了优先治疗对生命或肢体有直接威胁的患者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exercise-Associated Hyponatremic Encephalopathy, Rhabdomyolysis, and Acute Kidney Injury While Hiking in the Grand Canyon.

We present an unusual case of concomitant exercise-associated hyponatremic encephalopathy (EAHE), exertional rhabdomyolysis (ER), and acute kidney injury (AKI) in a Grand Canyon hiker. Our case patient, an adult 41-year-old male, consumed an excessive amount of water during his descent into the Canyon during hot weather. The next day, he was unable to hike out due to severe leg pain and disorientation, and ultimately evacuated by helicopter, having a grand mal seizure in flight. Despite having no serum sodium level, medics administered an intravenous (IV) bolus of 3% hypertonic saline (HTS) before transporting him to the hospital. There, he was diagnosed with EAHE (serum sodium, 114 mmol⋅L-1), ER, bilateral compartment syndromes, and mild AKI. The life-threatening EAHE was immediately corrected with more IV HTS, the limb-threatening compartment syndromes by surgical fasciotomies, and eventually, the AKI by oral and IV fluids. This case demonstrates the seriousness of overconsumption of water, as well as the potential complications of muscle damage when a deconditioned person does prolonged, strenuous exercise. Furthermore, it also illustrates the importance of considering EAHE within the differential diagnosis for acute alterations in level of consciousness. Lastly, it shows the importance to prioritize patient treatments for conditions that are an immediate threat to life or limb.

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来源期刊
Wilderness & Environmental Medicine
Wilderness & Environmental Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
2.10
自引率
7.10%
发文量
96
审稿时长
>12 weeks
期刊介绍: Wilderness & Environmental Medicine, the official journal of the Wilderness Medical Society, is the leading journal for physicians practicing medicine in austere environments. This quarterly journal features articles on all aspects of wilderness medicine, including high altitude and climbing, cold- and heat-related phenomena, natural environmental disasters, immersion and near-drowning, diving, and barotrauma, hazardous plants/animals/insects/marine animals, animal attacks, search and rescue, ethical and legal issues, aeromedial transport, survival physiology, medicine in remote environments, travel medicine, operational medicine, and wilderness trauma management. It presents original research and clinical reports from scientists and practitioners around the globe. WEM invites submissions from authors who want to take advantage of our established publication''s unique scope, wide readership, and international recognition in the field of wilderness medicine. Its readership is a diverse group of medical and outdoor professionals who choose WEM as their primary wilderness medical resource.
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