Hiker fatality from severe hyponatremia in Grand Canyon National Park
Open accessAbstract
We present the case of a hiker who died of severe hyponatremia at Grand Canyon National Park. The woman collapsed on the rim shortly after finishing a 5-hour hike into the Canyon during which she was reported to have consumed large quantities of water. First responders transported her to the nearest hospital. En route, she became unresponsive, and subsequent treatment included intravenous normal saline. Imaging and laboratory data at the hospital confirmed hypervolemic hyponatremia with encephalopathy. She never regained consciousness and died of severe cerebral edema less than 24 hours later. We believe this is the first report of a fatality due to acute hyponatremia associated with hiking in a wilderness setting. This case demonstrates the typical pathophysiology, which includes overconsumption of fluids, and demonstrates the challenges of diagnosis and the importance of appropriate acute management. Current treatment guidelines indicate that symptomatic exercise-associated hyponatremia should be acutely managed with hypertonic saline and can be done so without concern over central pontine myelinolysis, whereas treatment with high volumes of isotonic fluids may delay recovery and has even resulted in deaths.
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The signs and symptoms of EAH are nonspecific and can be superimposed on or confused with those of other diseases such as EHS, GI symptoms, and hypoglycemia.
“However, the signs and symptoms of EAH are nonspecific and can be superimposed on or confused with those of other diseases such as EHS, GI symptoms, and hypoglycemia, which are also frequent in these types of event.”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [47]
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- Authors
- Myers, T. M., & Hoffman, M. D.
- Affiliations
- Grand Canyon National Park (US)
- VA Northern California Health Care System (US)
- Corresponding author
- Myers, Thomas M.
- ORCID
- Hoffman, Martin D.
- Venue
- Wilderness & Environmental Medicine
- Publisher
- SAGE Publications
- Published
- 2015-09
- Volume
- 26
- Issue
- 3
- Pages
- 371-374
- ISSN
- 1080-6032 (ISSN-L)
- 1545-1534
- OpenAlex
- W2125908533
- Cited by
- 15
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 1
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Wilderness and Environmental Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › High Altitude and Hypoxia
- Keywords
- hyponatremia, exercise-associated hyponatremia, hypervolemic hyponatremia, cerebral edema, encephalopathy, fluid overload, fluid intake, hypertonic saline, central pontine myelinolysis, Grand Canyon National Park
- MeSH terms
- Parks, Recreational, Arizona, Physical Exertion, Female, Humans, Hyponatremia, Middle Aged, Physical Endurance, Saline Solution, Hypertonic, Fatal Outcome
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