Thursday, August 11, 2005

Hyponatremia death

It seems blogger just lost this post and all comments on it. Let me try again.


Today's Washington Post carried a sad story of yet another preventable death from hyponatremia of a promising young police offer. My questions:
  • Why wasn't the instructor on top of this situation? It's a predictable result of exercise and sweating for long periods of time in hot conditions.
  • Why did it take a paramedic (who happened to be on the scene) to notice that something was seriously wrong?
My thoughts on prevention are HERE. If someone has been exercising for a long period of time and is vomiting or nauseous and dizzy, think SALT replenishment, not water.



"District Officer Dies After Bike Ride: Over-Hydration Cited as Factor"
by Del Quentin Wilber and David Brown
Thursday, August 11, 2005; Page B01

"A highly honored 25-year-old D.C. police officer died yesterday after he apparently drank too much water Tuesday while training to use a bicycle on patrol, police officials said.

Doctors believe that hyponatremia, a sodium imbalance caused by drinking excessive amounts of fluid, most likely caused or contributed to the death of Officer James C. McBride, police officials said. McBride consumed as much as three gallons of water during and after the 12-mile training ride Tuesday morning, police said.

The doctors "did mention that he had consumed an awful lot of water," said D.C. Police Chief Charles H. Ramsey, adding that authorities are awaiting autopsy results. "They are saying that is a possibility it might have contributed. . . . This is something that is really unusual. We are usually concerned about dehydration as opposed to people consuming too much water."

Hyponatremia, an abnormally low salt concentration in the blood, occurs when a person loses a large amount of sodium or consumes a large amount of water. Hyponatremia in athletes is almost always caused by drinking too much water.

As the blood becomes increasingly diluted, water moves out of the bloodstream and into cells, which swell. The swelling of the brain is responsible for the symptoms of severe hyponatremia -- nausea, confusion, seizures and coma. If pressure inside the skull increases enough, the base of the brain is squeezed downward through where connects it to the spinal cord, causing death.

McBride, who joined the force two years ago, was named the 1st Police District's rookie of the year. Colleagues said he pushed supervisors to allow him to attend the weeklong bicycle training course so he could better patrol his beat, Sursum Corda -- a notoriously violent public housing complex off North Capitol Street.

"This guy is really out here hustling to make a difference," D.C. Police Inspector Andrew Solberg said. "I read the arrest reports, and it seemed like his name was on them all the time. He just seemed to be a central component in everything that was going on."

Mayor Anthony A. Williams (D) issued a statement saying McBride was an officer who "loved his city and who served it well." Police said McBride lived in Maryland.

McBride and 15 other officers started the course Monday at the department's academy complex in Southwest Washington. The next morning, the officers did a 12-mile training ride that included hills, police said.

About 2 p.m. Tuesday, McBride attended a training session that focused on how to dismount a bike. An instructor noticed that McBride looked ill and asked him to sit down. McBride complained of dizziness and nausea, police said. He then vomited, they said. Officers initially thought he might have suffered heat stroke.

Sgt. Timothy Evans, who ran the bike course, said he was not aware that McBride had drunk so much liquid and gave him some water to cool him down.

"I thought it was heat exhaustion," said Evans, who worked with McBride in the 1st District. "It never dawned on me that it might have been over-hydration."

At some point, McBride told an instructor that he had consumed perhaps as much as three gallons of water contained in a backpack he was carrying. Bicyclists often drink water through a tube connected to a bladder contained in such packs.

Officers said that McBride seemed to be recovering as he sat out the exercise. When another officer hurt his knee, police summoned an ambulance. The paramedics noticed that McBride was convulsing and continuing to vomit. They took him to Washington Hospital Center, where he died about 1:30 p.m. yesterday.

Many experts believe hyponatremia has become more common in recent years. More people are engaging in endurance events, such as marathons, that last many hours and during which participants are urged to drink water.

The blood concentration of sodium is normally about 145, measured in millimoles per liter. A study published in April in the New England Journal of Medicine found that in a random sample of 488 Boston Marathon runners, 22 percent of women and 8 percent of men had sodium levels below 135, the formal definition of hyponatremia. One participant, a 28-year-old woman, died of the condition.

In the Marine Corps Marathon last year in Virginia, four runners were treated for hyponatremia, and two were admitted to hospital intensive care units. A 35-year-old woman died of the condition in the 2002 race.

Some experts, however, caution against overreacting.

"We don't want to alarm people into drinking too little, because dehydration can cause problems as well," said Christopher Almond, a cardiologist at Children's Hospital in Boston who headed the Boston Marathon study.""

2 comments:

Dr. Iron TriFeist :) said...

Thought I already posted this but...why don't they include hydration education along with the physical conditioning? 3 gallons of water over 12 miles? Were they all uphill?

About Me: said...

ya, i found this troubling too. i mean, it seems we should know by now what too much water can do. or rather, those in higher ups should. but hopefully this will alert many more people to the danger of overdrinking, or really, proper intake of liquids. little solace to the family alas but maybe can prevent repeat