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Noakes TD, Sharwood K, Speedy D, et al.: Three independent biological mechanisms cause exercise-associated hyponatremia: Evidence from 2,135 weighed competitive athletic performance. Proc Natl Acad Sci U S A 2005, 102:18550-18555. This paper highlights three independent mechanisms to explain why some athletes develop exercise-associated hyponatremia/exercise- associated hyponatremic encephalopathy during and after prolonged exercise: 1) overdrinking due to biologic or psychologic factors, 2) inappropriate antidiuretic hormone secretion, and 3) a failure to mobilize NA+ from osmotically inactive sodium stores or inappropriate osmotic inactivation of circulating Na+. As the mechanisms causing reasons 1 and 2 are currently unknown, the authors recommend that athletes should be encouraged to avoid overdrinking during exercise.
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