Exercise-associated hyponatremia

Clinical Journal of the American Society of Nephrology

Volumn 2, Issue 1, 2007, Pages 151-161

  Rosner, Mitchell H ^a   Kirven, Justin ^a  

^a UNIVERSITY OF VIRGINIA HEALTH SYSTEM   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ENDURANCE; EXERCISE; HUMAN; HYPONATREMIA; INCIDENCE; PATHOPHYSIOLOGY; REVIEW; RISK FACTOR;

EXERCISE; HUMANS; HYPONATREMIA; INCIDENCE; PHYSICAL ENDURANCE; RISK FACTORS;

EID: 34247188519     PISSN: 15559041     EISSN: 1555905X     Source Type: Journal    
DOI: 10.2215/CJN.02730806     Document Type: Review

References (113)

1. Speedy DB, Noakes TD, Schneider C: Exercise-associated Hyponatremia: A review. Emerg Med (Fremantle) 13: 17-27, 2001
2. Kolata G: Marathoners warned about too much water. New York Times October 20, 2005, p B5
3. Noakes TD, Goodwin N, Rayner BL, Branken T, Taylor RK: Water intoxication: A possible complication during endurance exercise. Med Sci Sports Exerc 17: 370-375, 1985
4. Frizzell RH, Lang GH, Lathan R: Hyponatremia and ultramarathon running. JAMA 255: 772-774, 1986
5. Noakes TD: Overconsumption of fluids by athletes. BMJ 327: 113-114, 2003
6. Convertino VA, Armstrong LE, Coyle EF, Mack GW, Sawka MN, Senay LC Jr, Sherman WM: American College of Sports Medicine position stand: Exercise and fluid replacement. Med Sci Sports Exerc 28: i-vii, 1996
7. Wyndham C, Strydom N: The danger of an inadequate water intake during marathon running. S Afr Med J 43: 893-896, 1969
8. Murray B: Fluid replacement: The American College of Sports Medicine position stand. Sports Sci Exchange 9: 1-5, 1996
9. Noakes TD, Norman RJ, Buck J, Godlonton J, Stevenson K, Pittaway D: The incidence of hyponatremia during prolonged ultraendurance exercise. Med Sci Sports Exerc 22: 165-170, 1990
10. Hew TD, Chorley JN, Cianaca JC, Divine JG: The incidence, risk factors and clinical manifestations of hyponatremia in marathon runners. Clin J Sport Med 13: 41-47, 2003
11. Ayus JC, Varon J, Arieff AI: Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med 132: 711-714, 2000
12. Davis DP, Videen JS, Marino A, Vilke GM, Dunford JV, Van Camp SP, Maharam LG: Exercise-associated hyponatremia in marathon runners: A two-year experience. J Emerg Med 21: 47-57, 2001
13. Almond CS, Fortescue EB, Shin AY, et al.: Risk factors for hyponatremia among runners in the Boston marathon [Abstract]. Acad Emerg Med 10: 534-b - 535-b, 2003
14. Hew-Butler T, Almond C, Ayus JC, Dugas J, Meeuwisse W, Noakes T, Reid S, Siegel A, Speedy D, Stuempfle K, Verbalis J, Weschler L; Exercise-Associated Hyponatremia (EAH) Consensus Panel: Consensus statement of the 1st International Exercise-Associated Hyponatremia Consensus Development Conference, Cape Town, South Africa 2005. Clin J Sport Med 15: 208-213, 2005
15. Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, Duncan CN, Olson DP, Salerno AE, Newburger JW, Greenes DS: Hyponatremia among runners in the Boston Marathon. N Engl J Med 352: 1550-1556, 2005
16. Montain SJ, Sawka MN, Wenger CB: Hyponatremia associated with exercise: Risk factors and pathogenesis. Exerc Sports Sci Rev 3: 113-117, 2001
17. O'Toole ML, Douglas PS, Laird RH, Hiller WDB: Fluid and electrolyte status in athletes receiving medical care at an ultradistance triathlon. Clin J Sport Med 5: 116-122, 1995
18. Zelinger J, Putterman C, Yaron I, Dann E, Zveibil F, Shvil Y, Galon E: Case series: Hyponatremia associated with moderate exercise. Am J Med Sci 311: 86-91, 1996
19. Sharwood KA, Collins M, Goedecke JH, Wilson G, Noakes TD: Weight changes, medical complications, and performance during an Ironman triathlon. Br J Sports Med 38: 718-724, 2004
20. Sharwood K, Collins M, Goedecke J, Wilson G, Noakes T: Weight changes, sodium levels, and performance in the South African Ironman Triathlon. Clin J Sport Med 12: 391-399, 2002
21. Speedy DB, Noakes TD, Rogers IR, Thompson JM, Campbell RG, Kuttner JA, Boswell DR, Wright S, Hamlin M: Hyponatremia in ultradistance triathletes. Med Sci Sports Exerc 31: 809-815, 1999
22. Reid SA, Speedy DB, Thompson JM, Noakes TD, Mulligan G, Page T, Campbell RG, Milne C: Study of hematological and biochemical parameters in runners completing a standard marathon. Clin J Sports Med 14: 344-353, 2004
23. Wharam PC, Speedy DB, Noakes TD, Thompson JM, Reid SA, Holtzhausen LM: NSAID use increases the risk of developing hyponatremia during an Ironman triathlon. Med Sci Sports Exerc 38: 618-622, 2006
24. Clark JM, Gennari FJ: Encephalopathy due to severe hyponatremia in an ultramarathon runner. West J Med 159: 188-189, 1993
25. Surgenor S, Uphold RE: Acute hyponatremia in ultra-endurance athletes. Am J Emerg Med 12: 441-444, 1994
26. Smith S: Marathon runner's death linked to excessive fluid intake. Boston Globe August 13, 2002, p A1
27. O'Brien KK, Montain SJ, Corr WP, Sawka MN, Knapik JJ, Craig SC: Hyponatremia associated with overhydration in US Army trainees. Mil Med 166: 405-410, 2001
28. Garner JW: Death by water intoxication. Mil Med 167: 432-434, 2002
29. Garigan TP, Ristedt DE: Death from hyponatremia as a result of acute water intoxication in an Army basic trainee. Mil Med 164: 234-238, 1999
30. Montain SJ, Latska WA, Sawka MN: Fluid replacement recommendations for training in hot weather. Mil Med 164: 502-508, 1999
31. Noakes TD, Speedy DB: Case proven: Exercise associated hyponatremia is due to overdrinking. So why did it take 20 years before the original evidence was accepted? Br J Sports Med 40: 567-572, 2006
32. Noakes TD, Adams BA, Myburgh KH, Greeff C, Lotz T, Nathan M: The danger of an inadequate water intake during prolonged exercise. A novel concept revisited. Eur J Appl Physiol Occup Physiol 57: 210-219, 1988
33. Noakes TD: Hyponatremia during endurance running: A physiological and clinical interpretation. Med Sci Sports Exerc 24: 403-405, 1992
34. Noakes TD, Sharwood K, Speedy D, Hew T, Reid S, Dugas J, Almond C, Wharam P, Weschler L: Three independent biological mechanisms cause exercise-associated hyponatremia: Evidence from 2,135 weighed competitive athletic performances. Proc Natl Acad Sci U S A 102: 18550-18555, 2005
35. Dugas JP: Sodium ingestion and hyponatremia: Sports drinks do not prevent a fall in serum sodium concentration during exercise. Br J Sports Med 40: 372, 2006
36. Speedy DB, Noakes TD, Kimber NE, Rogers IR, Thompson JM, Boswell DR, Ross JJ, Campbell RG, Gallagher PG, Kuttner JA: Fluid balance during and after an ironman triathlon. Clin J Sport Med 11: 44-50, 2001
37. Twerenbold R, Knechtle B, Kakebeeke TH, Eser P, Muller G, von Arx P, Knecht H: Effects of different sodium concentrations in replacement fluids during prolonged exercise in women. Br J Sports Med 37: 300-303, 2003
38. Montain SJ, Cheuvront SN, Sawka MN: Exercise associated hyponatremia: Quantitative analysis to understand the etiology. Br J Sports Med 40: 98-106, 2006
39. Speedy DB: The drinking athlete. N Z J Sport Med 24: 33-34, 1996
40. Backer HD, Shopes E, Collins SJ, Barkan H: Exertional heat illness and hyponatremia in hikers. Am J Emerg Med 17: 532-539, 1999
41. US Army Center for Health Promotion and Preventive Medicine (USACHPPM): Overhydration and hyponatremia among active duty soldiers 1997-1999. Med Surveill Monthly Rep 6: 9-11, 2000
42. Baker LB, Munce TA, Kenney WL: Sex differences in voluntary fluid intake by older adults during exercise. Med Sci Sports Exerc 37: 789-796, 2005
43. Ayus JC, Wheeler JM, Arieff AI: Postoperative hyponatremic encephalopathy in menstruant females. Ann Intern Med 117: 891-897, 1992
44. Fraser CL, Swanson RA: Female sex hormones inhibit volume regulation in rat brain astrocyte culture. Am J Physiol Cell Physiol 267: C909-C914, 1994
45. Young M, Sciurba F, Rinaldo J: Delirium and pulmonary edema after completing a marathon. Am Rev Respir Dis 136: 737-739, 1987
46. Speedy DB, Rogers IR, Noakes TD, Wright S, Thompson JM, Campbell R, Hellemans I, Kimber NE, Boswell DR, Kuttner JA, Safih S: Exercise-induced hyponatremia in ultradistance athletes is caused by inappropriate fluid retention. Clin J Sport Med 10: 272-278, 2000
47. Hsieh M, Roth R, Davis DL, Larrabee H, Callaway CW: Hyponatremia in runners requiring on-site medical treatment at a single marathon. Med Sci Sports Exerc 34: 185-189, 2002
48. Breyer MD, Jacobson HR, Hebert RL: Cellular mechanisms of prostaglandin E2 and vasopressin interactions in the collecting duct. Kidney Int 38: 618-626, 1990
49. Stokes JD: Integrated actions of renal medullary prostaglandins in the control of water excretion. Am J Physiol 240: F471-F478, 1981
50. Hebert RL, Jacobson HR, Breyer MD: PGE2 inhibits AVP-induced water flow in cortical collecting ducts by protein kinase C activation. Am J Physiol 259: F318-F324, 1990
51. Patrono C, Dunn MJ: The clinical significance of inhibition of renal prostaglandin synthesis. Kidney Int 32: 1-10, 1987
52. Baker J, Cotter JD, Gerrad DF, Bell ML, Walker RJ: Effects of indomethacin and celecoxib on renal function in athletes. Med Sci Sports Exerc 37: 712-717, 2005
53. Rose BD, Post TW: Clinical Physiology of Acid-Base and Electrolyte Disorders, New York, McGraw Hill, 2001, pp 285-296
54. Pollock AS, Arieff AI: Abnormalities of cell volume regulation and their functional consequences. Am J Physiol 239: F195-F205, 1980
55. Noakes TD, Sharwood K, Collins M, Perkins DR: The dipsomania of great distance: Water intoxication in an Ironman triathlete. Br J Sports Med 38: E16, 2004
56. Gardner JW, Guttman FD: Fatal water intoxication of an Army trainee during urine drug testing. Mil Med 167: 435-437, 2002
57. Shapiro SA, Ejaz AA, Osborne MD, Taylor WC: Moderate exercise-induced hyponatremia. Clin J Sport Med 16: 72-73, 2006
58. Pivarnik JM, Leeds EM, Wilkerson JE: Effects of endurance exercise on metabolic water production and plasma volume. J Appl Physiol 56: 613-618, 1984
59. Olsson KE, Saltin B: Variation in total body water with muscle glycogen changes in man. Acta Physiol Scand 80: 11-18, 1970
60. Murray B, Stofan J, Eichner ER: Hyponatremia in athletes. Sports Sci Exchange 16: 1-6, 2003
61. Freund BJ, Shizuru EM, Hashiro GM, Claybaugh JR: Hormonal, electrolyte and renal responses to exercise are intensity dependent. J Appl Physiol 70: 900-906, 1991
62. Robertson GL: Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 119[Suppl 1]: S36-S42, 2006
63. Takamata A, Mack GW, Stachenfeld MS, Nadel ER: Body temperature modification of osmotically induced vasopressin secretion and thirst in humans. Am J Physiol 269: R874-R880, 1995
64. Galun E, Tur-Kaspa I, Assia E, Burstein R, Strauss N, Epstein Y, Popovtzer MM: Hyponatremia induced by exercise: A 24-hour endurance march study. Miner Electrolyte Metab 17: 315-320, 1991
65. Siegel AJ: Exercise-associated hyponatremia: Role of cytokines. Am J Med 119[Suppl 1]: S74-S78, 2006
66. Edwards KM, Burns VE, Ring C, Carroll D: Individual differences in the interleukin-6 response to maximal and submaximal exercise tasks. J Sports Sci 24: 855-862, 2006
67. Zaldivar F, Wang-Rodriguez J, Nemet D, Schwindt C, Galassetti P, Mills PJ, Wilson LD, Cooper DM: Constitutive pro- and anti-inflammatory cytokine and growth factor response to exercise in leukocytes. J Appl Physiol 100: 1124-1133, 2006
68. Mastorakos G, Weber JS, Magiakou MA, Gunn H, Chrousos GP: Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: Potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endrocrinol Metab 79: 934-939, 1994
69. Gionis D, Ilias I, Moustaki M, Mantzos E, Papadatos I, Koutras DA, Mastorakos G: Hypothalamic-pituitary-adrenal axis and interleukin-6 activity in children with head trauma and syndrome of inappropriate secretion of anti-diuretic hormone. J Pediatr Endocrinol Metab 16: 49-54, 2003
70. Terry CF, Loukaci V, Green FR: Cooperative influence of genetic polymorphisms on interleukin 6 transcriptional regulation. J Biol Chem 275: 18138-18144, 2000
71. Misharin AV, Resnenko AB, Fidelina OV, Grinevich VV, Akmaev IG: Anti-diuretic hormone-V2-receptor-aquaporin-2 system in rat kidneys during acute inflammation. Bull Exp Biol Med 138: 452-456, 2004
72. Speedy DB, Rogers I, Safih S, Foley B: Hyponatremia and seizures in an ultradistance triathlete. J Emerg Med 18: 41-44, 2000
73. van Nieuwenhoven MA, Vriens BEPJ, Brummer R-JM, Brouns F: Effect of dehydration on gastrointestinal function at rest and during exercise in humans. Eur J Appl Physiol 83: 578-584, 2000
74. Speedy DB, Noakes TD, Rogers IR, Hellemans I, Kimber NE, Boswell DR, Campbell R, Kuttner JA: A prospective study of exercise-associated hyponatremia in two ultradistance triathletes. Clin J Sport Med 10: 136-141, 2000
75. Nagashima K, Wu J, Kavouras SA, Mack GW: Increased renal tubular sodium reabsorption during exercise-induced hypervolemia in humans. J Appl Physiol 91: 1229-1236, 2001
76. Shirreffs SM, Aragon-Vargas LM, Chamorro M, Maughan RJ, Serratosa L, Zachwieja JJ: The sweating response of elite professional soccer players to training in the heat. Int J Sports Med 26: 90-95, 2005
77. Adams WC, Fox RH, Fry AJ, MacDonald IC: Thermoregulation during marathon running in cool, moderate and hot environments. J Appl Physiol 38: 1030-1037, 1975
78. Pugh LGCE, Corbett JL, Johnson RH: Rectal temperatures, weight losses and sweat rates in marathon running. J Appl Physiol 23: 347-352, 1967
79. Weschler LB: Exercise-associated hyponatremia: A mathematical review. Sports Med 35: 899-922, 2005
80. Smith HR, Dhatt GS, Melia WM, Dickinson JG: Cystic fibrosis presenting as hyponatremic heat exhaustion. BMJ 310: 579-580, 1995
81. Edelman IS, James AH, Brooks L, Moore FD: Body sodium and potassium: The normal total exchangeable sodium; its measurement and magnitude. Metabolism 3: 530-538, 1954
82. Edelman IS, James AH, Baden H, Moore FD: Electrolyte composition of bone and the penetration of radiosodium and deuterium oxide into dog and human bone. J Clin Invest 33: 122-131, 1954
83. Edelman IS, Leibman J, O'Meara MP, Birkenfeld LW: Interrelations between serum sodium concentration, serum osmolality and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest 37: 1236-1256, 1958
84. Titze J, Bauer K, Schafthuber M, Dietsch P, Lang R, Schwind KH, Luft FC, Eckardt KU, Hilgers KF: Internal sodium balance in DOCA-salt rats: A body composition study. Am J Physiol Renal Physiol 289: F793-F802, 2005
85. Titze J, Krause H, Hecht H, Dietsch P, Rittweger J, Lang R, Kirsch KA, Hilgers KF: Reduced osmotically inactive Na storage capacity and hypertension in the Dahl model. Am J Physiol Renal Physiol 283: F134-F141, 2002
86. Heer M, Baisch F, Kropp J, Gerzer R, Drummer C: High dietary sodium chloride consumption may not induce body fluid retention in humans. Am J Physiol Renal Physiol 278: F585-F595, 2000
87. Titze J, Lang R, Ilies C, Schwind KH, Kirsch KA, Dietsch P, Luft FC, Hilgers KF: Osmotically inactive skin Na+ storage in rats. Am J Physiol Renal Physiol 285: F1108-F1117, 2003
88. Titze J, Shakibaei M, Shafthuber M, Schulze-Tanzil G, Porst M, Schwind KH, Dietsch P, Hilgers KF: Glycosaminoglycan polymerization may enable osmotically inactive Na+ storage in the skin. Am J Physiol Heart Circ Physiol 287: H203-H208, 2004
89. Nolph KD, Schrier RW: Sodium, potassium and water metabolism in the syndrome of inappropriate antidiuretic hormone secretion. Am J Med 49: 534-545, 1970
90. Bartter FC, Schwartz WB: The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42: 790-806, 1967
91. Seelinger E, Ladwig M, Reinhardt HW: Are large amounts of sodium stored in an osmotically inactive form during sodium retention? Balance studies in freely moving dogs. Am J Physiol Regul Integr Comp Physiol 290: R1429-R1435, 2006
92. Halperin ML, Kamel KS, Sterns R. Letter to the editor: Hyponatremia in marathon runners. N Engl J Med 353: 428, 2005
93. Shafiee MA, Charest AF, Cheema-Dhadli S, Glick DN, Napolova O, Roozbeh J, Semenova E, Sharman A, Halperin ML: Defining conditions that lead to the retention of water: The importance of the arterial sodium concentration. Kidney Int 67: 613-621, 2005
94. Welt LG, Orloff J, Kydd DM, Oltman JE: An example of cellular hyperosmolarity. J Clin Invest 29: 935-939, 1950
95. Noakes T: Fluid replacement during marathon running. Clin J Sport Med 13: 309-318, 2003
96. Casa DJ: USATF Self-Testing Program for Optimal Hydration, 2003. Available at: http://www.usatf.org/groups/Coaches/library/hydration/ USATFSelfTestingProgramForOptimalHydration.pdf. Accessed September 9, 2006
97. Casa DJ: USATF Proper Hydration for Distance Running, 2003. Available at: http://www.usatf.org/groups/Coaches/library/hydration/ ProperHydrationForDistanceRunning.pdf. Accessed September 9, 2006
98. Noakes TD: IMMDA advisory statement on guidelines for fluid replacement during marathon running. New studies in athletics. IAAF Technical Quarterly 17: 15-24, 2002
99. Speedy DB, Rogers IR, Noakes TD, Thompson JM, Guirey J, Safih S, Boswell DR: Diagnosis and prevention of hyponatremia at an ultradistance triathlon. Clin J Sport Med 10: 52-58, 2000
100. Noakes TD: Sodium ingestion and the prevention of hyponatremia during exercise. Br J Sports Med 38: 790-793, 2004
101. Speedy DB, Thompson JM, Rodgers I, Collins M, Sharwood K, Noakes TD: Oral salt supplementation during ultradistance exercise. Clin J Sport Med 12: 279-284, 2002
102. Vrijens DM, Rehrer NJ: Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat. J Appl Physiol 86: 1847-1851, 1999
103. Hsieh M: Recommendations for treatment of hyponatremia at endurance events. Sports Med 34: 231-238, 2004
104. Ayus JC, Olivero JJ, Frommer JP: Rapid correction of severe hyponatremia with intravenous hypertonic saline solution. Am J Med 72: 43-48, 1982
105. Ayus JC, Krothapalli RK, Arieff AI: Treatment of symptomatic hyponatremia and its relation to brain damage. A prospective study. N Engl J Med 317: 1190-1195, 1987
106. Ayus JC, Arieff A, Moritz ML: Hyponatremia in marathon runners. N Engl J Med 353: 427, 2005
107. Narins RG: Therapy of hyponatremia: Does haste make waste? N Engl J Med 314: 1573-1574, 1986
108. Androgue HJ, Madias NE: Hyponatremia. N Engl J Med 342: 1581-1589, 2000
109. Palm C, Pistrosch F, Herbrig K, Gross P: Vasopressin antagonists as aquaretic agents for the treatment of hyponatremia. Am J Med 119[Suppl 1]: S87-S92, 2006
110. Decaux G: Difference in solute excretion during correction of hyponatremic patients with cirrhosis or syndrome of inappropriate secretion of antidiuretic hormone by oral vasopressin V2 receptor antagonist VPA-985. J Lab Clin Med 138: 18-21, 2001
111. Greenberg A, Verbalis JG: Vasopressin receptor antagonists. Kidney Int 69: 2124-2130, 2006
112. Lindinger MI: Potassium regulation during exercise and recovery in humans: Implications for skeletal and cardiac muscle. J Mol Cell Cardiol 27: 1011-1022, 1995
113. Lohr JW: Osmotic demyelination syndrome following correction of hyponatremia: Association with hypokalemia. Am J Med 96: 408-413, 1994