BMJ Case Reports 2009; doi:10.1136/bcr.04.2009.1764
  • Learning from errors

Pulmonary oedema and hyponatraemia after an ironman triathlon

  1. Georgia Stefanko1,
  2. Bill Lancashire2,
  3. Jeff S Coombes3,
  4. Robert G Fassett4
  1. 1
    Prince of Wales Hospital, Sydney, New South Wales, 2000, Australia
  2. 2
    Port Macquarie Base Hospital, Port Macquarie, New South Wales, 2000, Australia
  3. 3
    The University of Queensland, St Lucia, Brisbane, Queensland, 4000, Australia
  4. 4
    Royal Brisbane and Women’s Hospital and The University of Queensland, Renal Medicine, Level 9 Ned Hanlon Building, Brisbane, Queensland, 4029, Australia
  1. Robert G Fassett, rfassett{at}
  • Published 17 August 2009


A 36-year-old man presented with symptoms of acute pulmonary oedema at the conclusion of the Australian ironman triathlon. He was alert, orientated, with an oxygen saturation of 75% on room air. Chest examination revealed bilateral basal crepitations. Serum sodium was 120 mmol/L and chest x ray revealed bilateral basal opacities. He was treated for acute pulmonary oedema with prompt improvement and given 200 ml of intravenous hypertonic saline followed by normal saline. Serum sodium decreased to 117 mmol/L and 30 hours after presentation he had a seizure. He fully recovered and was discharged 5 days after admission. This case highlights that exercise-associated hyponatraemia and pulmonary oedema are still not widely understood and there is still a reluctance to treat hyponatraemia aggressively with ongoing hypertonic saline.


  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

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