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60-811: The Kokoda Track or Trail is a single-file foot thoroughfare that runs 96 kilometres (60 mi) overland – 60 kilometres (37 mi) in a straight line – through the Owen Stanley Range in Papua New Guinea (PNG). The track was the location of the 1942 World War II battle between Japanese and Allied – primarily Australian – forces in what was then the Australian territory of Papua . The track runs from Owers' Corner in Central Province , 50 kilometres (31 mi) east of Port Moresby , across rugged and isolated terrain which

120-422: A grasp of the size of the body fluid compartments and subcompartments and their regulation; how under normal circumstances the body is able to maintain the sodium concentration within a narrow range ( homeostasis of body fluid osmolality ); conditions can cause that feedback system to malfunction ( pathophysiology ); and the consequences of the malfunction of that system on the size and solute concentration of

180-433: A higher solute diet. If large volumes of dilute urine are seen, this can be a warning sign that overcorrection is imminent in these individuals. Sodium deficit = (140 – serum sodium) × total body water Total body water = kilograms of body weight × 0.6   Options include: In persons with hyponatremia due to low blood volume (hypovolemia) from diuretics with simultaneous low blood potassium levels , correction of

240-589: A key reason for cultural listing along with the unique cultures of the Koiari peoples. The Owen Stanley Ranges, through which the Kokoda Track passes, is one of the most biologically important areas in the Asia Pacific with over 4000 plant species and many endemic bird and animal species. The Kokoda Track Foundation , established in 2003, helps villages along the track with education and healthcare. There

300-405: A large polar structure too large to pass through the cell membrane: "channels" or "pumps" are required. Cell swelling also produces activation of volume-regulated anion channels which is related to the release of taurine and glutamate from astrocytes. The history, physical exam, and laboratory testing are required to determine the underlying cause of hyponatremia. A blood test demonstrating

360-422: A person's body fluid status into low volume , normal volume, or high volume . Low volume hyponatremia can occur from diarrhea , vomiting , diuretics , and sweating . Normal volume hyponatremia is divided into cases with dilute urine and concentrated urine. Cases in which the urine is dilute include adrenal insufficiency , hypothyroidism , and drinking too much water or too much beer . Cases in which

420-619: A quarter days without guides, carriers or any signposts or bridges. In 2006, the Owen Stanley Ranges and Kokoda Track was included on the Tentative List for World Heritage along with three other sites from PNG. The 1.5 million hectare property is a mixed cultural and natural site covering a significant proportion of the Owen Stanley Ranges and including the Kokoda Track, Managalas Plateau and Mount Victoria and Mount Albert Edward region. The World War II battle sites were

480-474: A review of medical articles from 1946 to 2016. Available evidence suggests that all classes of psychotropics , i.e., antidepressants , antipsychotics , mood stabilizers, and sedative/ hypnotics can lead to hyponatremia. Age is a significant factor for drug induced hyponatremia. Miscellaneous causes that are not included under the above classification scheme include the following: The causes of and treatments for hyponatremia can only be understood by having

540-495: A section of the track to make way for a copper mine. The plan has the support of the local landowners and the Papua New Guinean government but has been criticised by trekking operators. The track has been closed numerous times by villagers along the route in response to various grievances. In May 2009, villagers at Kovelo – near Kokoda village – blocked the track after complaints that money collected from trekking fees

600-534: A serum sodium less than 135 mmol/L is diagnostic for hyponatremia. The history and physical exam are necessary to help determine if the person is hypovolemic, euvolemic, or hypervolemic, which has important implications in determining the underlying cause. An assessment is also made to determine if the person is experiencing symptoms from their hyponatremia. These include assessments of alertness, concentration, and orientation. False hyponatremia, also known as spurious, pseudo, hypertonic, or artifactual hyponatremia

660-513: A specified volume of serum/plasma, or that dilute the sample before analysis. True hyponatremia, also known as hypotonic hyponatremia, is the most common type. It is often simply referred to as "hyponatremia." Hypotonic hyponatremia is categorized in 3 ways based on the person's blood volume status. Each category represents a different underlying reason for the increase in ADH that led to the water retention and thence hyponatremia: Chronic hyponatremia

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720-514: A winning time of 17 hours, 49 minutes and 17 seconds. A Sydney engineer, Damon Goerke, 32 became the first Australian to run the track in under 24 hours, coming third in the 2006 challenge with a time of just under 19.5 hours. The race record was again broken by Buka in the 2007 event when he completed the track in 17 hours 20 minutes on 26 August 2007, running in the reverse direction from Kokoda to Owers' Corner. The 2007 event also featured runners running from Owers' Corner to Kokoda and

780-443: A winning time of 19 hours 9 minutes was set in this direction by Tom Hango. Megan Davidson, a trek leader with Back Track Adventures, was the first Australian female to run the track in 36 hours, coming 12th overall. On 31 August 2008, Buka once again set a new record, with a time of 16:34:05. The conditions were the worst that they had been in the three years that Buka had competed in the event. Wayne Urina, claiming second place,

840-437: Is Brendan Buka, with a best time of 16:34.05 in 2008 from Owers Corner to Kokoda and a time of 17:20 in the direction of Kokoda to Owers' Corner via Naduri. The inaugural race of 27 August 2005 was won by John Hunt Hiviki, who completed it in 22 hours, one minute and 14 seconds. On 27 August 2006, Brendan Buka, a 22-year-old Papua New Guinean trekking porter from Kokoda , conquered the trail from Owers' Corner to Kokoda in

900-445: Is a proposal to turn the track into an Australian heritage destination on a par with ANZAC Cove at Gallipoli . Creation of the heritage area, is in part a response to the issue of an Australian gold mining company wanting to mine on or near the track. As of 2007, the idea was backed by the Australian government and Papua New Guinea's foreign minister. In November 2007, Australian mining firm Frontier Resources announced plans to divert

960-410: Is an increased ADH even though there is no normal stimulus (elevated serum sodium) for ADH to be increased. Hyponatremia occurs in one of two ways: either the osmoreceptor-aquaporin feedback loop is overwhelmed , or it is interrupted . If it is interrupted, it is either related or not related to ADH. If the feedback system is overwhelmed, this is water intoxication with maximally dilute urine and

1020-951: Is associated with an increased risk of death. The economic costs of hyponatremia are estimated at $ 2.6 billion per annum in the United States. Signs and symptoms of hyponatremia include nausea and vomiting , headache , short-term memory loss , confusion , lethargy , fatigue , loss of appetite , irritability , muscle weakness , spasms or cramps , seizures , and decreased consciousness or coma . Lower levels of plasma sodium are associated with more severe symptoms. However, mild hyponatremia (plasma sodium levels at 131–135 mmol/L) may be associated with complications and subtle symptoms (for example, increased falls, altered posture and gait, reduced attention, impaired cognition, and possibly higher rates of death). Neurological symptoms typically occur with very low levels of plasma sodium (usually <115 mmol/L). When sodium levels in

1080-527: Is caused by 1) pathological water drinking ( psychogenic polydipsia ), 2) beer potomania , 3) overzealous intravenous solute free water infusion, or 4) infantile water intoxication. "Impairment of urine diluting ability related to ADH" occurs in nine situations: 1) arterial volume depletion 2) hemodynamically mediated, 3) congestive heart failure, 4) cirrhosis, 5) nephrosis, 6) spinal cord disease, 7) Addison's disease, 8) cerebral salt wasting, and 9) syndrome of inappropriate antidiuretic hormone secretion (SIADH). If

1140-600: Is currently the second fastest man to complete the crossing of the Kokoda Trail with a time of 18:34:06. Cyprian Aire came third with 19:11:40. In 2011, the Kokoda Challenge Race was run on 27 August. The race started from Owers' Corner and finished at the new Kokoda Archway. The race was organised and sponsored by Kokoda Trekking. Brendan Buka once again won the race in a time of 17:50:33 but did not break his 2008 record. The Kokoda Challenge Race in 2012

1200-500: Is insufficiently responsive to fluid restriction and/or sodium tablets. Demeclocycline , while sometimes used for SIADH, has significant side effects including potential kidney problems and sun sensitivity . In many people it has no benefit while in others it can result in overcorrection and high blood sodium levels. Daily use of urea by mouth, while not commonly used due to the taste, has tentative evidence in SIADH. However, it

1260-548: Is more frequent in females, the elderly, and in people who are hospitalized. The number of cases of hyponatremia depends largely on the population. In hospital it affects about 15–20% of people; however, only 3–5% of people who are hospitalized have a sodium level less than 130 mmol/L. Hyponatremia has been reported in up to 30% of the elderly in nursing homes and is also present in approximately 30% of people who are depressed on selective serotonin reuptake inhibitors . People who have hyponatremia who require hospitalisation have

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1320-402: Is not available in many areas of the world. Raising the serum sodium concentration too rapidly may cause osmotic demyelination syndrome . Rapid correction of sodium levels can also lead to central pontine myelinolysis (CPM) . It is recommended not to raise the serum sodium by more than 10 mEq/L/day. Hyponatremia is the most commonly seen water–electrolyte imbalance . The disorder

1380-537: Is only passable on foot, to the village of Kokoda in Oro Province . It reaches a height of 2,490 metres (8,169 ft) as it passes around the peak of Mount Bellamy . The track travels primarily through the land of the Mountain Koiari people. Hot, humid days with intensely cold nights, torrential rainfall and the risk of endemic tropical diseases such as malaria make it a challenging trek. Hiking

1440-451: Is typically treated with both fluid restriction and a diet low in salt. Correction should generally be gradual in those in whom the low levels have been present for more than two days. Hyponatremia is the most common type of electrolyte imbalance , and is often found in older adults. It occurs in about 20% of those admitted to hospital and 10% of people during or after an endurance sporting event. Among those in hospital, hyponatremia

1500-551: Is when sodium levels drop gradually over several days or weeks and symptoms and complications are typically moderate. Chronic hyponatremia is often called asymptomatic hyponatremia in clinical settings because it is thought to have no symptoms; however, emerging data suggests that "asymptomatic" hyponatremia is not actually asymptomatic. Acute hyponatremia is when sodium levels drop rapidly, resulting in potentially dangerous effects, such as rapid brain swelling, which can result in coma and death. The treatment of hyponatremia depends on

1560-421: Is when the lab tests read low sodium levels but there is no hypotonicity . In hypertonic hyponatremia, resorption of water by molecules such as glucose (hyperglycemia or diabetes) or mannitol (hypertonic infusion) occurs. In isotonic hyponatremia a measurement error due to high blood triglyceride level (most common) or paraproteinemia occurs. It occurs when using techniques that measure the amount of sodium in

1620-447: The blood . It is generally defined as a sodium concentration of less than 135  mmol/L (135  mEq/L ), with severe hyponatremia being below 120 mEq/L. Symptoms can be absent, mild or severe. Mild symptoms include a decreased ability to think , headaches , nausea , and poor balance . Severe symptoms include confusion, seizures , and coma ; death can ensue. The causes of hyponatremia are typically classified by

1680-413: The 130 miles (210 km) track over extraordinarily difficult jungle terrain, from 14 October to 20 November 1942. Immense ridges, or "razorbacks," followed each other in succession like the teeth of a saw. As a rule, the only way the troops could get up these ridges, which were steeper than along the Kokoda Trail, was either on hands and knees, or by cutting steps into them with ax and machete. To rest,

1740-498: The 1990s, with the Australian Macquarie Dictionary stating that while both versions were in use, Kokoda Track "appears to be the more popular of the two". The track can be walked from either direction. It can take up to 12 days to complete, depending on fitness and rest time involved. Locals are renowned for being able to regularly complete it in 3 days. There are a number of guesthouses located along

1800-589: The 70th anniversary of the Kokoda Campaign. The two Japanese runners, Makoto Yoshimoto and Yukiya Higuchi finished in a time of 42:56:36. Owen Stanley Range Owen Stanley Range was seen in 1849 by Captain Owen Stanley while surveying the south coast of Papua and named after him. The eastern extremity of the range is Mount Victoria , which was climbed by Sir William MacGregor in 1888, and it extends as far west as Mount Thynne and Lilley . But

1860-575: The Australian Army's 2/33rd Battalion records the route being officially designated as the "Kokoda Trail" in September 1942. The Australian Army has used "Kokoda Trail" as a battle honour since 1957. The Australian War Memorial (AWM) says that " trail " is probably of United States origin but has been used in many Australian history books and "appears to be used more widely". Despite the historical use of "Trail", "Track" gained dominance in

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1920-619: The Track and ensure their porters and guides are treated in a professional manner. A list of licensed operators is available on its website. Trekkers walking with unlicensed operators will be stopped by the KTA rangers and the local people. The Kokoda Challenge Race is an endurance running race that was revived on 27 August 2005. The race originally ran in 1975 but stopped before becoming an annual event. The Kokoda Challenge inaugural race commenced in 2005. The current race record holder in both directions

1980-509: The blood become very low, water enters the brain cells and causes them to swell ( cerebral edema ). This results in increased pressure in the skull and causes hyponatremic encephalopathy . As pressure increases in the skull, herniation of the brain can occur, which is a squeezing of the brain across the internal structures of the skull. This can lead to headache, nausea, vomiting, confusion, seizures , brain stem compression and respiratory arrest , and non-cardiogenic accumulation of fluid in

2040-416: The blood sodium concentration. These groups include persons who have hypovolemic hyponatremia and receive intravenous fluids (thus correcting their hypovolemia), persons with adrenal insufficiency who receive hydrocortisone , persons in whom a medication causing increased ADH release has been stopped, and persons who have hyponatremia due to decreased salt and/or solute intake in their diet who are treated with

2100-426: The bloodstream and signals the kidney to bring back sufficient solute-free water from the fluid in the kidney tubules to dilute the serum sodium back to normal, and this turns off the osmoreceptors in the hypothalamus. Also, thirst is stimulated. Normally, when mild hyponatremia begins to occur, that is, the serum sodium begins to fall below 135 mEq/L, there is no secretion of ADH, and the kidney stops returning water to

2160-438: The body from the kidney tubule. Also, no thirst is experienced. These two act in concert to raise the serum sodium to the normal range. Hyponatremia occurs 1) when the hypothalamic-kidney feedback loop is overwhelmed by increased fluid intake, 2) the feedback loop malfunctions such that ADH is always "turned on", 3) the receptors in the kidney are always "open" regardless of there being no signal from ADH to be open; or 4) there

2220-537: The crash. As a result, the Australian Government committed $ 1.8 million to improve the safety of airstrips at Kokoda , Menari, Kagi, Melei, Efogi, and Naduri, villages located along the track. A second radio channel was also installed to deal with emergencies and maintenance work. In October 2009, Don Vale became the oldest Australian (at 83) to successfully complete the Kokoda Track. In November 2009, Australian paralympian Kurt Fearnley (born without

2280-528: The easiest being the famous Kokoda Track which crosses the range between Port Moresby and Buna and was in use for more than 50 years as a regular overland mail-route. Another route used by the 900 men of the US 2nd Battalion, 126th Infantry Regiment , 32nd Division , was the Kapa Kapa Trail , parallel to but 30 miles (48 km) to the southeast of the Kokoda Track. They took nearly five weeks to cover

2340-463: The feed-back system is normal, but an impairment of urine diluting ability unrelated to ADH occurs, this is 1) oliguric kidney failure, 2) tubular interstitial kidney disease, 3) diuretics, or 4) nephrogenic syndrome of antidiuresis. Sodium is the primary positively charged ion outside of the cell and cannot cross from the interstitial space into the cell. This is because charged sodium ions attract around them up to 25 water molecules, thereby creating

2400-437: The fluid compartments. There is a hypothalamic-kidney feedback system which normally maintains the concentration of the serum sodium within a narrow range. This system operates as follows: in some of the cells of the hypothalamus , there are osmoreceptors which respond to an elevated serum sodium in body fluids by signalling the posterior pituitary gland to secrete antidiuretic hormone (ADH) ( vasopressin ). ADH then enters

2460-620: The grounds it would burden his comrades. There has been much debate in Australia about whether it should be called the "Kokoda Trail" or the "Kokoda Track". The monument at Owers' Corner uses both terms: "Track" on one side and "Trail" on the other. The earliest mention of the route in an Australian newspaper may be in The Argus on Wednesday 29 July 1942 in a map when it refers to "the Buna Kokoda-Moresby track". "Kokoda Trail"

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2520-682: The low potassium level can assist with correction of hyponatremia. American and European guidelines come to different conclusions regarding the use of medications. In the United States they are recommended in those with SIADH, cirrhosis, or heart failure who fail limiting fluid intake. In Europe they are not generally recommended. There is tentative evidence that vasopressin receptor antagonists (vaptans), such as conivaptan , may be slightly more effective than fluid restriction in those with high volume or normal volume hyponatremia. They should not be used in people with low volume. They may also be used in people with chronic hyponatremia due to SIADH that

2580-457: The lower section of his spine) completed the track, crawling north to south, in 11 days. A multiple paralympic gold medalist (T54 Marathon in Athens and Beijing), he used customized shin pads and wrist guards. His journey was to raise awareness of men's health issues and was inspired by the story of Corporal John Metson, who crawled the track for three weeks, refusing the assistance of a stretcher on

2640-421: The lungs . This is usually fatal if not immediately treated. Symptom severity depends on how fast and how severe the drop in blood sodium level is. A gradual drop, even to very low levels, may be tolerated well if it occurs over several days or weeks, because of neuronal adaptation. The presence of underlying neurological disease such as a seizure disorder or non-neurological metabolic abnormalities, also affects

2700-501: The men simply leaned forward, holding on to vines and roots in order to keep themselves from slipping down the mountainside. Vehicular roads, though not impossible, would be very difficult and expensive to construct. In fact one was constructed during World War II crossing from Wau in the north to Bulldog in the south and known as the Bulldog Track . It was largely due to the impossibility of transporting heavy equipment across

2760-559: The name is generally used to denote the whole of the chain of the Papuan Peninsula , from Mount Chapman 3,376 metres (11,076 ft) to the south-eastern end of the island, and to include Mount Albert Edward 3,990 m (13,091 ft) which is really separated from it by the Wharton Chain. The range is flanked by broken and difficult country, particularly on the south-western side. There are few practicable passes,

2820-492: The person has high fluid volume, normal fluid volume, or low fluid volume. Both sodium and water content increase: Increase in sodium content leads to hypervolemia and water content to hyponatremia. There is volume expansion in the body, no edema, but hyponatremia occurs Hypovolemia (extracellular volume loss) is due to total body sodium loss. Hyponatremia is caused by a relatively smaller loss in total body water. Antipsychotics have been reported to cause hyponatremia in

2880-607: The price payable in Port Moresby. The Kokoda Track Authority (the PNG Special Purpose Authority with responsibility for managing the Track) requires tour operators to hold a Commercial Operators Licence to lead treks along the Kokoda Track and purchase a trek permit. Licensed operators carry first aid kits, undertake first aid training, carry radios or satellite phones, respect the people who live along

2940-478: The range that the Japanese failed to secure Port Moresby as a base early in 1942. The mountains are rough and precipitous, with occasional fertile plateaus which are occupied by native food-gardens. Two species of reptiles are named after Owen Stanley Range, Papuascincus stanleyanus and Toxicocalamus stanleyanus . Hyponatremia Hyponatremia or hyponatraemia is a low concentration of sodium in

3000-426: The severity of neurologic symptoms. Hyponatremia, by interfering with bone metabolism, has been linked with a doubled risk of osteoporosis and an increased risk of bone fracture . The specific causes of hyponatremia are generally divided into those with low tonicity (lower than normal concentration of solutes ), without low tonicity, and falsely low sodiums. Those with low tonicity are then grouped by whether

3060-757: The trail normally takes between four and twelve days; the fastest recorded time is 16 hours 34 minutes. The track was first used by European miners in the 1890s to access the Yodda Kokoda goldfields. Between July 1942 and November 1942, a series of battles, afterwards called the Kokoda Track campaign , was fought between the Japanese and Australian forces. This action was memorialised in the newsreel documentary Kokoda Front Line! , filmed by cameraman Damien Parer , which won Australia 's first Academy Award for its director Ken G. Hall in 1942. After

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3120-570: The trail's popularity increased, there were calls for more regulation of trek operators, with some operators taking as many as 150 walkers in a group. In response, the Kokoda Track Authority announced that from the beginning of 2010, tour operators would require a commercial licence. In August 2009, a group of trekkers were killed when their light plane, Airlines PNG Flight 4684 , crashed en route to Kokoda Station. All 13 people on board, including 9 Australian trekkers, were killed in

3180-459: The underlying cause. Correcting hyponatremia too quickly can lead to complications. Rapid partial correction with 3% normal saline is only recommended in those with significant symptoms and occasionally those in whom the condition was of rapid onset. Low volume hyponatremia is typically treated with intravenous normal saline . SIADH is typically treated by correcting the underlying cause and with fluid restriction while high volume hyponatremia

3240-453: The underlying cause. How quickly treatment is required depends on a person's symptoms. Fluids are typically the cornerstone of initial management. In those with severe disease an increase in sodium of about 5 mmol/L over one to four hours is recommended. A rapid rise in serum sodium is anticipated in certain groups when the cause of the hyponatremia is addressed thus warranting closer monitoring in order to avoid overly rapid correction of

3300-401: The urine is concentrated include syndrome of inappropriate antidiuretic hormone secretion (SIADH). High volume hyponatremia can occur from heart failure , liver failure , and kidney failure . Conditions that can lead to falsely low sodium measurements include high blood protein levels such as in multiple myeloma , high blood fat levels , and high blood sugar . Treatment is based on

3360-417: The war, the track fell into disuse and disappeared in many places. John Landy , the long-distance runner, set a record of four days for the crossing using carriers and guides during the 1950s. In 1964, Angus Henry, the art teacher at Sogeri High School , with two of his students, John Kadiba and Misty Baloiloi, set a new record which was to stand until after the millennium by completing the journey in three and

3420-481: The way, some at villages and others at traditional rest spots. The main villages passed through (from Owers' Corner) are Naoro, Menari, Efogi Creek 1 & 2, Kagi or Naduri (if shortcut is taken), Alolo, Isurava, Hoi, Kovolo. Villagers are increasingly taking part in the commercial opportunities created by the growing number of tourists; in October 2006, some were known to be selling cans of soft drink and beer at double

3480-710: Was gazetted as the official name of the route by the Australian administration of Papua New Guinea in 1972. According to historian Stuart Hawthorne, before World War II, the route was referred to as "the overland mail route" or "the Buna road". He states that "Kokoda Trail" became common because of its use in Australian newspapers during the war, the first known instance being in Sydney's Daily Mirror on 27 October 1942. However, all three terms Kokoda Track, Kokoda Trail and Buna-Kokoda road were commonly used during World War II in Australian newspapers from September 1942. The diary of

3540-510: Was not being distributed fairly. Since 2001, there has been a rapid increase in the number of people walking the track (see table at right). Six Australian trekkers have died from hyponatremia while attempting to walk the track. Four of those deaths occurred in 2009, with two in the same week in April and another two 8 days apart in September and October. The deaths have sparked calls for mandatory fitness tests for all walkers before starting. As

3600-480: Was run on 25 August. The race began from the Kokoda Archway and went for the first time via Kagi Village to Owers' Corner. The race was once again sponsored by Kokoda Trekking. The winner was trail porter Ramsy Idau of Kokoda, with a time of 18:28:00. Prize money was set at K10,000 PNG Kina. The race saw for the first time two Japanese runners competing against the eight Australians and 22 Papua New Guineans, on

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