Hazards of ultra-marathon running in the Scottish Highlands: exercise-associated hyponatraemia.

The case histories are presented of four athletes taking part in a 95-mile ultra-endurance foot race in Scotland who were hospitalised after developing exercise-associated hyponatraemia and rhabdomyolysis. Exercise-associated hyponatraemia is relatively uncommon in temperate climates. Risk factors disposing to this disorder are discussed. Exercise-associated hyponatraemia is thought to be due to overconsumption of hypotonic fluid with other associated pathophysiology including an inability to suppress fully antidiuretic hormone during exercise or to mobilise adequate sodium from osmotically inactive internal stores. Non-specific symptoms make this disorder difficult to diagnose on site without the assistance of serum sodium measurement, but any delay in treatment of patients with encephalopathy can prove fatal. Mainstays of treatment include fluid restriction, hypertonic saline, loop diuretics and mannitol.

Anaesthesia--a sedentary specialty? Accelerometer assessment of the activity level of anaesthetists while at work.

Current guidance recommends that all adults should take a minimum of 10,000 steps a day to remain healthy. We assessed the activity levels of 45 anaesthetists while at work, using accelerometers. These devices also allowed us to measure sitting, standing and walking time--features of the working day that are also likely to contribute to health and well-being. In addition, each anaesthetist was asked to guess how many steps they had taken and complete a questionnaire assessing current activity levels. Median (IQR [range]) number of steps taken per day at work was 3694 (2435-4646 [1444-7712]). Almost all anaesthetists underestimated the number of steps they had taken. We concluded that no anaesthetists in our study were able to take the recommended 10,000 steps solely during their working day. A concerted effort is required in recreational time to ensure anaesthetists stay fit and healthy.

Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section.

A parturient presented with her first symptoms of coronary artery disease at 18 weeks' gestation. Following an angiogram, a drug-eluting stent was inserted, resulting in resolution of her symptoms. The patient was prescribed anti-platelet medication including clopidogrel. She was delivered by elective caesarean section at 35 weeks under general anaesthesia. The anaesthetic management is discussed and a review of the literature presented.