Kokoda Medicine

The popularity of the Kokoda Trail has increased dramatically over the last decade.  More and more Australians are making the arduous trek through the muddy, steep terrain of the Owen Stanley Range in Papua New Guinea.

This fantastic adventure serves as a moving military history shrine and, for some, the ultimate mental and physical challenge.

The first case of severe exercise-associated hyponatraemia in Kokoda occurred in 2006, with a second case in 2008.  In addition, six apparently healthy trekkers have died on the track since 2006, their causes of death unknown.

In April this year, Dr Sean Rothwell and Dr David Rosengren led a research expedition to investigate the prevalence of exercise-associated hyponatremia (EAH) on the Kokoda Trail.

Funded by the Kokoda Track Authority and expertly guided by Executive Excellence, the team collected blood from nearly 200 people over a four day period in trying conditions in the Papua New Guinean jungle. They were joined by Michael Usher and his crew from 60 Minutes who compiled this great story first aired on 60 minutes June 6th 2010. Read the full transcript of ‘tracking a killer’ or watch the full 60 minutes video of the research expedition

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Double-Click Image to play movie

Most of the trekkers had normal blood tests results.  However a small number of them demonstrated mild hyponatraemia.  These trekkers had consumed a large amount of fluids.  They were observed for a few hours of fluid restriction, and their sodium returned to normal.

EAH is caused by excessive fluid intake in the setting of exercise-induced ADH release.  This causes a dilutional hyponatraemia which manifests as headache, nausea, confusion, ataxia, seizures, coma and ultimately death

The Kokoda Track is a safe and fantastic experience for nearly all trekkers .  This study has confirmed that a small number of trekkers are susceptible to the potentially fatal EAH.

The best way to avoid EAH is to only drink when you are thirsty.

Obviously drink enough fluids to prevent dehydration…but don’t overdo it

References:

  • Tracking a Killer – 60 Minutes June 6th 2010 [Video Interview] [Transcript] [Slideshow] [Blog]
  • Kokoda Track Research – Adventure Medicine
  • Rothwell SP, Rosengren DJ. Severe exercise-associated hyponatremia on the Kokoda Trail, Papua New Guinea. Wilderness Environ Med. 2008 Spring;19(1):42-4. PMID 18333641
  • Exercise-associated hyponatremia – clinical quiz
  • Hyponatraemia – the basics
  • Hyponatremia – Wikipedia
  • O’Connor RE. Exercise-induced hyponatremia: causes, risks, prevention, and management. Cleve Clin J Med. 2006 Sep;73 Suppl 3:S13-8. Review. PubMed PMID: 16970148. (fulltext)
  • Rogers IR, Hew-Butler T. Exercise-associated hyponatremia: overzealous fluid consumption. Wilderness Environ Med. 2009 Summer;20(2):139-43. PMID: 19594207 (fulltext)
  • Rosner MH, Kirven J.  Exercise-associated hyponatremia. 2007 Jan;2(1):151-61. PMID:17699400 (fulltext)
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