Pathophysiology and treatment of exercise-associated hyponatremia

Hew-Butler T, Rosner MH, Fowkes-Godek S, Dugas JP, Hoffman MD, Lewis DP, Maughan RJ, Miller KC, Montain SJ, Rehrer NJ, Roberts WO, Rogers IR, Siegel AJ, Stuempfle KJ, Winger JM, Verbalis JG (2015) Statement of the third international Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med 25(4):303–320. https://doi.org/10.1097/JSM.0000000000000221

Article  PubMed  Google Scholar 

Verbalis JG (2007) Renal function and vasopressin during marathon running. Sports Med 37(4–5):455–458. https://doi.org/10.2165/00007256-200737040-00048

Article  PubMed  Google Scholar 

Hew-Butler T, Jordaan E, Stuempfle KJ, Speedy DB, Siegel AJ, Noakes TD, Soldin SJ, Verbalis JG (2008) Osmotic and nonosmotic regulation of arginine vasopressin during prolonged endurance exercise. J Clin Endocrinol Metab 93(6):2072–2078. https://doi.org/10.1210/jc.2007-2336

Article  PubMed  PubMed Central  CAS  Google Scholar 

Hew-Butler T, Dugas JP, Noakes TD, Verbalis JG (2010) Changes in plasma arginine vasopressin concentrations in cyclists participating in a 109-km cycle race. Br J Sports Med 44(8):594–597. https://doi.org/10.1136/bjsm.2008.049742

Article  PubMed  CAS  Google Scholar 

Cairns RS, Hew-Butler T (2015) Incidence of exercise-associated hyponatremia and its association with nonosmotic stimuli of arginine vasopressin in the GNW100s ultra-endurance marathon. Clin J Sport Med 25(4):347–354. https://doi.org/10.1097/JSM.0000000000000144

Article  PubMed  Google Scholar 

Hew-Butler T (2019) Exercise-associated hyponatremia. Front Horm Res 52:178–189. https://doi.org/10.1159/000493247

Article  PubMed  CAS  Google Scholar 

Ayus JC, Varon J, Arieff AI (2000) Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med 132(9):711–714. https://doi.org/10.7326/0003-4819-132-9-200005020-00005

Article  PubMed  CAS  Google Scholar 

M Sawka, M.N Burke, L.M Eichner, E.R Maughan, R.J Montain, S.J Stachenfeld. N.S.: American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007.39(2) 377–390. https://doi.org/10.1249/mss.0b013e31802ca597

Klingert M, Nikolaidis P.T., Weiss, K., Thuany, M., Chlibkova, D., Knechtle, B.: Exercise-Associated Hyponatremia in Marathon Runners. J Clin Med. 2022.11 (22). https://doi.org/10.3390/jcm11226775

Reid SA, Speedy DB, Thompson JM, Noakes TD, Mulligan G, Page T, Campbell RG, Milne C (2004) Study of hematological and biochemical parameters in runners completing a standard marathon. Clin J Sport Med 14(6):344–353. https://doi.org/10.1097/00042752-200411000-00004

Article  PubMed  Google Scholar 

Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, Duncan CN, Olson DP, Salerno AE, Newburger JW, Greenes DS (2005) Hyponatremia among runners in the Boston Marathon. N Engl J Med 352(15):1550–1556. https://doi.org/10.1056/NEJMoa043901

Article  PubMed  CAS  Google Scholar 

Danz M, Pottgen K, Tonjes PM, Hinkelbein J, Braunecker S (2016) Hyponatremia among triathletes in the Ironman European Championship. N Engl J Med 374(10):997–998. https://doi.org/10.1056/NEJMc1510409

Article  PubMed  Google Scholar 

Bradshaw CJ, Bundy M, Falvey E (2008) The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med 42(10):851–854. https://doi.org/10.1136/bjsm.2007.039685

Article  PubMed  CAS  Google Scholar 

Cohen D (2012) The truth about sports drinks. BMJ 345:e4737. https://doi.org/10.1136/bmj.e4737

Article  PubMed  Google Scholar 

Changstrom B, Brill J, Hecht S (2017) Severe exercise-associated hyponatremia in a collegiate American football player. Curr Sports Med Rep 16(5):343–345. https://doi.org/10.1249/JSR.0000000000000399

Article  PubMed  Google Scholar 

Elsaesser TF, Pang PS, Malik S, Chiampas GT (2013) Large-volume hypertonic saline therapy in endurance athlete with exercise-associated hyponatremic encephalopathy. J Emerg Med 44(6):1132–1135. https://doi.org/10.1016/j.jemermed.2012.11.048

Article  PubMed  Google Scholar 

Bennett BL, Hew-Butler T, Rosner MH, Myers T, Lipman GS (2020) Wilderness medical society clinical practice guidelines for the management of exercise-associated hyponatremia: 2019 update. Wilderness Environ Med 31(1):50–62. https://doi.org/10.1016/j.wem.2019.11.003

Article  PubMed  Google Scholar 

Oh RC, Galer M, Bursey MM (2018) Found in the field - a soldier with heat stroke, exercise-associated hyponatremia, and kidney injury. Curr Sports Med Rep 17(4):123–125. https://doi.org/10.1249/JSR.0000000000000471

Article  PubMed  Google Scholar 

Kipps C, Sharma S, Tunstall Pedoe D (2011) The incidence of exercise-associated hyponatraemia in the London Marathon. Br J Sports Med 45(1):14–19. https://doi.org/10.1136/bjsm.2009.059535

Article  PubMed  Google Scholar 

Mayer CU, Treff G, Fenske WK, Blouin K, Steinacker JM, Allolio B (2015) High incidence of hyponatremia in rowers during a four-week training camp. Am J Med 128(10):1144–1151. https://doi.org/10.1016/j.amjmed.2015.04.014

Article  PubMed  CAS  Google Scholar 

Mohseni M, Silvers S, McNeil R, Diehl N, Vadeboncoeur T, Taylor W, Shapiro S, Roth J, Mahoney S (2011) Prevalence of hyponatremia, renal dysfunction, and other electrolyte abnormalities among runners before and after completing a marathon or half marathon. Sports Health 3(2):145–151. https://doi.org/10.1177/1941738111400561

Article  PubMed  PubMed Central  Google Scholar 

Armstrong LE, Lee EC, Casa DJ, Johnson EC, Ganio MS, McDermott BP, Vingren JL, Oh HM, Williamson KH (2017) Exertional hyponatremia and serum sodium change during ultraendurance cycling. Int J Sport Nutr Exerc Metab 27(2):139–147. https://doi.org/10.1123/ijsnem.2016-0135

Article  PubMed  CAS  Google Scholar 

Jones BL, O’Hara JP, Till K, King RF (2015) Dehydration and hyponatremia in professional rugby union players: a cohort study observing English premiership rugby union players during match play, field, and gym training in cool environmental conditions. J Strength Cond Res 29(1):107–115. https://doi.org/10.1519/JSC.0000000000000620

Article  PubMed  Google Scholar 

Bridges E, Altherwi T, Correa JA, Hew-Butler T (2020) Oral hypertonic saline is effective in reversing acute mild-to-moderate symptomatic exercise-associated hyponatremia. Clin J Sport Med 30(1):8–13. https://doi.org/10.1097/JSM.0000000000000573

Article  PubMed  Google Scholar 

Oh RC, Malave B, Chaltry JD (2018) Collapse in the heat - from overhydration to the emergency room - three cases of exercise-associated hyponatremia associated with exertional heat illness. Mil Med 183(3–4):e225–e228. https://doi.org/10.1093/milmed/usx105

Article  PubMed  Google Scholar 

Buck E, McAllister R, Schroeder JD (2024) Exercise-Associated Hyponatremia. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Rebecca McAllister declares no relevant financial relationships with ineligible companies. Disclosure: Jeremy Schroeder declares no relevant financial relationships with ineligible companies.

Payne M (2014) A high school football player dies after reportedly consuming two gallons each of water and Gatorade. https://www.washingtonpost.com/news/early-lead/wp/2014/08/13/a-high-school-football-player-dies-after-reportedly-consuming-two-gallons-each-of-water-and-gatorade/. Accessed 20/10/2024

Hew-Butler T, Loi V, Pani A, Rosner MH (2017) Exercise-Associated Hyponatremia: 2017 Update. Front Med (Lausanne) 4:21. https://doi.org/10.3389/fmed.2017.00021

Article  PubMed  Google Scholar 

Krabel, H.: Athlete dies after IM Frankfurt. https://www.slowtwitch.com/news/athlete-dies-after-im-frankfurt/. 2015.

Baumgarder, A.: Au Sable River Canoe Marathon Pushes Paddlers to the Limits. https://www.mlive.com/sports/bay-city/2009/07/au_sable_river_canoe_marathon.html. 2009.

Garigan TP, Ristedt DE (1999) Death from hyponatremia as a result of acute water intoxication in an Army basic trainee. Mil Med 164(3):234–238

Article  PubMed  CAS  Google Scholar 

Nolte HW, Hew-Butler T, Noakes TD, Duvenage CS (2015) Exercise-associated hyponatremic encephalopathy and exertional heatstroke in a soldier: high rates of fluid intake during exercise caused rather than prevented a fatal outcome. Phys Sportsmed 43(1):93–98. https://doi.org/10.1080/00913847.2015.1001714

Article  PubMed  Google Scholar 

Chorley J, Cianca J, Divine J (2007) Risk factors for exercise-associated hyponatremia in non-elite marathon runners. Clin J Sport Med 17(6):471–477. https://doi.org/10.1097/JSM.0b013e3181588790

Article  PubMed  Google Scholar 

Knechtle B, Chlibkova D, Papadopoulou S, Mantzorou M, Rosemann T, Nikolaidis PT (2019) Exercise-associated hyponatremia in endurance and ultra-endurance performance-aspects of sex, race location, ambient temperature, sports discipline, and length of performance: a narrative review. Medicina (Kaunas). https://doi.org/10.3390/medicina55090537

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