Table 1 Death due to brainstem herniation in rehydration related hyponatremia.
Reference | Gender | Age (years) | Race | Activity | Na (mM) | Presentation |
|---|---|---|---|---|---|---|
[1] | F | 28 | Equatorian | Marathon | --- | Said she felt dehydrated, rubber-legged and fell to the pavement. She received rehydration. The time to brainstem herniation was not published. She lost consciousness prior to admission and died in hospital the following day. |
[9,10] | M | 18 | Alaska native (Inuit, Yupik) | Military marksmanship training at a temperature of 1190 F (43 C). | 121 | Dizziness, throbbing headache and nausea. With aggressive rehydration (at one stage, 10 U.S. Quarts/9.5 liter in 90 minutes) he started to vomit. Within four hours from the first symptoms, fixed and dilated pupils were recorded. A chest X-ray showed pulmonary oedema. In intensive care he developed sepsis and disseminated intravascular coagulation and died several days later of cardiac arrest. The postmortem showed diffuse cerebral and brainstem oedema, pituitary infarction [9] and hydrocephalus [10]. (Reference 9 and 10 refer to the same patient. Dr Karen O'Brien, personal communication) |
[4] | F | 32 | --- | Marathon1 | 117 | Details on symptoms or time course not published2. She developed nephrogenic diabetes insipidus and ws treated with fluid restriction. She died of cardiac arrest due to brainstem herniation. The autopsy confirmed brainstem herniation and showed pituitary infarction. (Dr Allen Arieff, personal communication) |
Present | M | In his 30's | Caucasian | Marathon | 130 | Light-headedness and headaches. After rehydration he started to vomit and afterwards suffered a respiratory arrest. The CT brain scan showed midbrain herniation into the foramen magnum and severe hydrocephalus (Figure 1A&B). Formal brainstem death testing was performed 16 hours after he collapsed. |