Exercise-associated hyponatremia figure 6

Figure 6. Hyvon Ngetich crawling across the finish line to finish 3rd at the 2015 Houston Marathon from the KXAN video ((https://www.youtube.com/watch?v=7ngym4Z2SPw). In full disclosure, I do not know what her post-race sodium level was, but the way she loses muscle control and coordination in her legs and needs to crawl, is strikingly similar to that seen in the video ((https://www.youtube.com/watch?v=tXTrCiAk0Yk) of Brian Morrison, who was known to have EAH with critically low sodium measured at a nearby hospital after he crossed the finish line at the 2006 Western States 100. (Though the symptoms (such as confusion) associated with exertional heat stroke can be similar to that of EAH, an important distinction is that runners with heat stroke should not lose coordination or control of their muscles, as is shown in these videos. That loss of coordination is due to swelling of the brain and would not be expected in heat stroke. If temperatures are hot, and heat stroke is suspected, a rectal temperature of >104 F/40 C would confirm heat stroke. Please see Liza Howard’s article here (https://irunfar.com/2018/07/trail-first-aid-heat-exhaustion-and-heat-stroke.html) for more information. If hyponatremia is suspected, this can be confirmed or ruled out with an i-STAT point of care machine (see below)).