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Is Hyperkalemia the Cause of Sudden Death in Young Healthy Athletes?

INTRODUCTION It is perhaps within the experience of every forensic pathologist that uncommonly an unexplained death is encountered in a teenager or young adolescent during exercise when the decedent is known to have been fit and healthy, with no known past medical history and often with a record of repeated and prolonged conditioning to exercise. In such cases the most meticulous autopsy examination, inclusive of a full examination of the conducting system of the heart, the removal and the examination of appropriate toxicological specimens, and a full histological sampling of the internal organs fails to provide a cause of death or an explanation of the terminal event. Maron et al. (1980) failed to find an explanation for one of the 29 exercise-related deaths which were studied by them in the 13 to 30 age group; Dolmans et al. (1984) could not account for 5 of the 29 deaths between the ages of 12 and 35 years in their series. Over the last five years I was involved in the investigation of five such deaths. In each case a meticulous autopsy was carried out including a full toxicological survey. Hyperpyrexia was not recorded in any ofthese cases.