• Sean P Rothwell and David J Rosengren.
• Royal Brisbane and Women's Hospital, Queensland, Australia. sean_rothwell@health.qld.gov.au
• Wilderness Environ Med. 2008 Jan 1;19(1):42-4.

AbstractExercise-associated hyponatremia is the most common medical complication of ultradistance exercise and is usually caused by excessive hypotonic fluid intake. We report a case of severe hyponatremia in a healthy male trekking the Kokoda Trail in the remote Southern Highlands of Papua New Guinea. A 43-year-old male collapsed and had a generalized seizure in the afternoon of the third day of a guided trek. He was evacuated the following morning and was found to have a serum sodium level of 107 mmol/L on arrival to hospital. The case highlights that a high index of suspicion is required to identify patients with exercise-associated hyponatremia. Early diagnosis and appropriate management is critical to avoid the potentially fatal consequences of severe hyponatremia. The diagnosis and treatment of exercise-associated hyponatremia is particularly challenging in the remote Papua New Guinea jungle. Education of trek leaders, medics, and trekkers in appropriate preventative measures and the rapid treatment of exercise-associated hyponatremia is essential to avoid recurrences of this life-threatening condition.

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