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Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(11/12): 696-702
DOI: 10.1055/s-0032-1331366
Fachwissen
Notfallmedizin
© Georg Thieme Verlag Stuttgart · New York

Kasuistik interaktiv – Ein Marathon mit dramatischen Folgen

Serious complications following a marathon run – Interactivecase report of a dramatic course
Rüdiger Spormann
,
Ulf Harding
,
Markus Stuhr
,
Joachim Röther
,
Klaus Püschel
,
Florian Reifferscheid
Further Information

Publication History

Publication Date:
12 December 2012 (online)

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Zusammenfassung

Ein Marathonläufer kollabiert nach dem Zieleinlauf und zeigt neurologische Symptome. NachErstversorgung vor Ort finden sich in der Klinik eine Hyponatriämie und ein Hirnödem. Er muss für 6 Tage intensivmedizinisch behandelt werden. Ursächlich ist eine „Exercise-associatedHyponatremia“ (EAH). Diese seltene Erkrankung tritt nach körperlicher Ausdauerbelastung auf und beruht auf einer akuten Verdünnungshyponatriämie. Symptome können Erbrechen, Desorientierung, Verwirrtheit und Krampfanfälle bis zum Koma sein. Die Behandlung besteht in einer Flüssigkeitsrestriktion und der Gabe von hypertoner Kochsalzlösung. Alle kollabierten, neurologisch auffälligen Marathonathleten sollten vor Ort eine Natrium-Messung erhalten, umzwischen EAH und Dehydratation unterscheiden zu können.

A marathon runner collapses after crossing the finish line and shows neurological disorders. Aftertreatment at the scene hyponatremia and cerebral edema are found at hospital admission. Thepatient is treated for “exercise-associated hyponatremia” (EAH) on the ICU for six days. This raredisease occurs following endurance exercise and is based on an acute dilutionalhyponatremia.Symptoms include nausea and vomiting, desorientation, dizziness, seizures or coma. Therapyincludes fluid restriction and application of hypertonic saline. Plasma sodium concentration shouldbe checked at the scene in all collapsed athletes showing neurological symptoms to differentiatebetween exercise-associated hyponatremia and dehydration.

Kernaussagen

  • Ein Kollaps nach Ausdauersportbelastung kann Ausdruck einer transienten lageabhängigen Hypotension, aber auch von Dehydratation oder einer EAH sein.

  • Dehydratation und EAH können zu neurologischen Symptomen führen.

  • Hauptgefahr der EAH ist die Entwicklung eines Hirnödems.

  • Eine sichere (präklinische) Differenzierung gelingt mit einer Serumnatriummessung.

  • Flüssigkeitsrestriktion und die Gabe hyperosmolarer Natriumlösung sind die Notfallbehandlung einer schweren EAH.

Schlüsselwörter:

Exercise-associated Hyponatremia - Marathon - Hirnödem - Ausdauersport - Sanitätsdienst - Hyponatriämie

Key-Words:

Exercise-associated Hyponatremia - marathon - cerebral edema - endurance sports - medical services

Ergänzendes Material

 

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