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Rare disease
Exercise associated hyponatraemia leading to tonic-clonic seizure
  1. Carl J Reynolds,
  2. Barbara J Cleaver,
  3. Sarah E Finlay
  1. Accident and Emergency Department, Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr Carl J Reynolds, c.reynolds{at}


A 34-year-old Filipino lady presented to the emergency department with breathlessness and muscle cramping following a Bikram yoga workout. The patient reported sweating excessively while performing 90 min of strenuous exertion in a humidified room heated to an ambient temperature of 40.6°C. After the workout she drank 3.5 litres of water before experiencing breathlessness, severe muscle cramps, nausea and general malaise. Initial investigations revealed severe hyponatraemia (120 mmol/l). Despite early sodium replacement the patient dropped her Glasgow coma scale to 9/15 and developed tonic clonic seizures, requiring intubation and admission to the intensive care unit. The hyponatraemia was slowly corrected on the intensive care unit and the patient made a full recovery over the course of 5 days. This case highlights the dangers of overzealous fluid replacement following severe exertion in a hot environment.

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  • Competing interests None.

  • Patient consent Obtained.