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Evaluation and Treatment of Exertional Heat Illness, Rhabdomyolysis, and Hyponatremia

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Endurance Sports Medicine

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Abstract

Exertional heat illness (EHI) and exertional rhabdomyolysis (ER) are seen in athletes and military members due to repetitive, intense, and/or prolonged exercise. An athlete who is experiencing the most severe form of EHI, known as exertional heat stroke (EHS), must be identified and removed from activity immediately, as well as provided aggressive, on-site whole body cooling in order to improve their likelihood of survival. Most EHI and EHS can be prevented with proper heat acclimatization, work/rest ratios, and hydration. Exertional rhabdomyolysis is diagnosed when severe muscle symptoms are accompanied by laboratory evidence of myonecrosis (CK > 5× upper limit of normal) in the setting or recent exertion. ER may range from mild to severe and accordingly may be treated as an outpatient or inpatient. Core principles of care include rest, aggressive hydration, and monitoring for complications. Also seen in endurance sports, exercise-associated hyponatremia is a potential mimicker of EHI that must be recognized. It is typically seen in novice athletes undergoing prolonged exercise who feel that they need to hydrate frequently. Treatment of mild cases includes hypotonic fluid restriction and administration of oral broth. More severe cases require one or more boluses of 3% saline and possibly admission to intensive care.

No financial disclosures were reported by the authors of this paper.

The opinions herein are those of the authors. They do not represent the official policy of the Department of Defense or any of its components.

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Authors and Affiliations

  1. Department of Family Medicine, St. Elizabeth’s Hospital, O’Fallon, IL, USA

    Jordan Romick

  2. Emergency Department, Osan Air Base, Pyeongtaek, Gyeonggi Province, Republic of Korea

    Rukayat Balogun

  3. Department of Sports Medicine, Ft. Belvoir Community Hospital, Fort Belvoir, VA, USA

    Nathaniel Nye

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  1. Jordan Romick
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  2. Rukayat Balogun
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  3. Nathaniel Nye
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Correspondence to Jordan Romick .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, New Albany, Columbus, OH, USA

    Timothy L. Miller

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Romick, J., Balogun, R., Nye, N. (2023). Evaluation and Treatment of Exertional Heat Illness, Rhabdomyolysis, and Hyponatremia. In: Miller, T.L. (eds) Endurance Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-26600-3_5

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  • DOI: https://doi.org/10.1007/978-3-031-26600-3_5

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