Bethan E Owen1, Ian R Rogers2, Martin D Hoffman3, Kristin J Stuempfle4, Douglas Lewis5, Kevin Fogard6, Joseph G Verbalis7, Tamara Hew-Butler8. 1. Sir Charles Gairdner Hospital, Australia. 2. St John of God Murdoch Hospital and University of Notre Dame, Australia. 3. VA Northern California Health Care System, United States; University of California Davis Medical Center, United States. 4. Gettysburg College, United States. 5. Via Christi family MEDICAL residency, United States. 6. VA Northern California Health Care System, United States. 7. Georgetown University Medical Center, United States. 8. Oakland University, United States. Electronic address: hew@oakland.edu.
Abstract
OBJECTIVES: To determine more conclusively whether intravenous (IV) administration of 3% saline is more efficacious than oral administration in reversing below normal blood sodium concentrations in runners with biochemical hyponatremia. DESIGN: Randomized controlled trial. METHODS:26 hyponatremic race finishers participating in the 161-km Western States Endurance Run were randomized to receive either an oral (n=11) or IV (n=15) 100mL bolus of 3% saline. Blood sodium concentration (Na(+)), plasma protein (to assess %plasma volume change), arginine vasopressin (AVP), blood urea nitrogen (BUN) and urine (Na(+)) were measured before and 60 min following the 3% saline intervention. RESULTS: No significant differences were noted with respect to pre- to post-intervention blood [Na(+)] change between intervention groups, although blood [Na(+)] increased over time in both intervention groups (+2 mmol/L; p<0.0001). Subjects receiving the IV bolus had a greater mean (± SD) plasma volume increase (+8.6 ± 4.5% versus 1.4% ± 5.7%; p<0.01) without significant change in [AVP] (-0.2 ± 2.6 versus 0.0 ± 0.5 pg/mL; p=0.49). 69% of subjects completing the intervention trial were able to produce urine at race finish with a mean (± SD) pre-intervention urine [Na(+)] of 15.2 ± 8.5 mmol/L (range 0-35; NS between groups). [BUN] of the entire cohort pre-intervention was 30.7 ± 10.5mg/dL (range 13-50). CONCLUSIONS: No group difference was noted in the primary outcome measure of change in blood [Na(+)] over 60 min of observation following a 100mL bolus of either oral or IV 3% saline. Administration of an oral hypertonic saline solution can be efficacious in reversing low blood sodium levels in runners with mild EAH.
RCT Entities:
OBJECTIVES: To determine more conclusively whether intravenous (IV) administration of 3% saline is more efficacious than oral administration in reversing below normal blood sodium concentrations in runners with biochemical hyponatremia. DESIGN: Randomized controlled trial. METHODS: 26 hyponatremic race finishers participating in the 161-km Western States Endurance Run were randomized to receive either an oral (n=11) or IV (n=15) 100mL bolus of 3% saline. Blood sodium concentration (Na(+)), plasma protein (to assess %plasma volume change), arginine vasopressin (AVP), blood ureanitrogen (BUN) and urine (Na(+)) were measured before and 60 min following the 3% saline intervention. RESULTS: No significant differences were noted with respect to pre- to post-intervention blood [Na(+)] change between intervention groups, although blood [Na(+)] increased over time in both intervention groups (+2 mmol/L; p<0.0001). Subjects receiving the IV bolus had a greater mean (± SD) plasma volume increase (+8.6 ± 4.5% versus 1.4% ± 5.7%; p<0.01) without significant change in [AVP] (-0.2 ± 2.6 versus 0.0 ± 0.5 pg/mL; p=0.49). 69% of subjects completing the intervention trial were able to produce urine at race finish with a mean (± SD) pre-intervention urine [Na(+)] of 15.2 ± 8.5 mmol/L (range 0-35; NS between groups). [BUN] of the entire cohort pre-intervention was 30.7 ± 10.5mg/dL (range 13-50). CONCLUSIONS: No group difference was noted in the primary outcome measure of change in blood [Na(+)] over 60 min of observation following a 100mL bolus of either oral or IV 3% saline. Administration of an oral hypertonicsaline solution can be efficacious in reversing low blood sodium levels in runners with mild EAH.
Authors: Martin D Hoffman; Andy Pasternak; Ian R Rogers; Morteza Khodaee; John C Hill; David A Townes; Bernd Volker Scheer; Brian J Krabak; Patrick Basset; Grant S Lipman Journal: Sports Med Date: 2014-08 Impact factor: 11.136
Authors: Evi V Nagler; Maria C Haller; Wim Van Biesen; Raymond Vanholder; Jonathan C Craig; Angela C Webster Journal: Cochrane Database Syst Rev Date: 2018-06-28