International Exercise-Associated Hyponatremia Registry:
Physician's Report Form

The collection of data on EAH cases is part of an ongoing effort by the Exercise-Associated Hyponatremia Consensus Group (EAH Group) to enable worldwide cooperation and understanding of EAH towards the prevention and eradication of this entity from endurance sport.

Confidentiality Principles:

The EAH Group will obey the strict practices of confidentiality and anonymity. The identity of each subject will only be known to the researchers and in order to maintain anonymity, numbers will be allocated in lieu of names. The data generated will be stored in a secure facility and confidentiality will be insured. The data will be used by the EAH Group for scientific research purposes only.

Thank you for your cooperation and concern. If you have any questions or concerns regarding the registry, please contact us.

NOTE: A report form can also be downloaded as part of the 2007 EAH Consensus Statement.

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PATIENT INFORMATION

1. Sex: Female Male
2. Age (years): 
3. How many times previously completed an event this distance or longer: 
4. If this race was completed, what was the finishing time:    hours   minutes
5. How many times did the patient urinate while on the course: 
6.  Were NSAIDs (non-steroidal anti-inflammatories) taken during the race:
   Type / number / dosage
   
   
   
7.  Were NSAIDs (non-steroidal anti-inflammatories) taken during the 12 hours before the race
   Type / number / dosage  
   
   
   
8. History of EAH in previous events:  Yes  No

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MEDICAL WORKUP

1. Location of collapse:
   before finish after finish (brought into medical tent
   <12 hours after finish (brought into emergency room)
2. Approximate time at the onset of medical attention: 
3. Initial serum sodium (mmol/l):
4. Presentation: asymptomatic symptomatic
5. Symptoms:
   bloating
   puffiness
   headache
   nausea
   vomiting
   altered mental status
   obtundation
   agitation
   respiratory distress
   seizures
   coma
   other:
   
   
6. Duration of major symptoms:

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MEDICAL TREATMENT

1.  Fluid restriction
2.  Observation
3.  Oral sodium tablets food liquid
4.   Hypertonic saline:
   (if yes, concentration and amount given):        
   
   
5.   Other IV fluid: 
   (if yes, type, concentration and amount given):
   
   
6.   Other treatment provided:
   > (if yes, describe):
   
   
7. Hospitalization required: Yes No
8. Comments:

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MEDICAL TENT INFORMATION

1. Electrolyte analyzer available onsite   yes   no
2. Hypertonic saline available onsite        yes   no
3. Pre-race weights obtained on competitors  yes   no
4. Previous experience with treating EAH       yes   no
5. Number of collapsed athletes seen in medical tent:
6. Number of athletes sent to hospital:

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RACE INFORMATION

1. Event name:
2. Event year:
3. Event distance:                   kms   miles 
4. Event location:
5. Number of starters:
6. Number of finishers:
7. Number of refreshment stations on course:
8. Describe beverages provided along course:
9. Were athletes alerted to the dangers of overhydration prior to race:          yes   no
10. Was hydration advice distributed to participants prior to race: oral written  yes   no
                        (If written, please forward copies!!!)
11. Temperature at start of race:
12. Maximum race temperature:

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REPORTING PHYSICIAN'S INFORMATION

1. Name:       
2. Position:    
3. Email:           
4. Telephone:     
   
   
5. Comments:

Thank you for your information, time and assistance.  Please click on the "Submit" button below to send  this information.  

    

                                  

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