Exercise-Induced Hyponatremia in Ultradistance Triathletes Is Caused By Inappropriate Fluid Retention

Speedy, Dale B.; Rogers, Ian R.; Noakes, Timothy D.; Wright, Susan; Thompson, John M. D.; Campbell, Robert G.; Hellemans, Ien J.; Kimber, Nicholas E.; Boswell, D. Ross; Kuttner, Jonathan; Safih, Shameem

doi:10.1097/00042752-200010000-00009

Cited by 101 publications

(96 citation statements)

References 21 publications

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“…Speedy et al measured both vasopressin and aldosterone in five subjects and 11 controls after an Ironman triathlon. 4 The median post race aldosterone in the subjects did not differ significantly from the controls. They found no evidence that aldosterone contributed to fluid retention.…”

Section: Discussionmentioning

confidence: 69%

“…4 Fluid retention, however was not associated with an increased activity of vasopressin in Ironman triathletes. 4 The association of vasopressin with effect on renal function and association with EAH has been investigated in marathon runners. 18 Marathon runners developing EAH showed an increase in body mass 19,20 and it was assumed that inappropriate anti-diuretic hormone release during exercise altered renal function 20 which may lead to water retention and EAH 21 .…”

Section: Introductionmentioning

confidence: 91%

“…4,17 Ironman triathletes with symptomatic EAH showed abnormal fluid retention with an increased extracellular volume. 4 Fluid retention, however was not associated with an increased activity of vasopressin in Ironman triathletes. 4 The association of vasopressin with effect on renal function and association with EAH has been investigated in marathon runners.…”

Section: Introductionmentioning

confidence: 97%

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Effect of a Multistage Ultraendurance Triathlon on Aldosterone, Vasopressin, Extracellular Water and Urine Electrolytes

et al. 2012

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Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 97%

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Effect of a Multistage Ultraendurance Triathlon on Aldosterone, Vasopressin, Extracellular Water and Urine Electrolytes

et al. 2012

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“…Those who have run fewer marathons (less experienced runners), have slower training paces, and have longer race times (especially Ͼ4 h) each were shown independently to have a significantly higher risk for developing hyponatremia (10,12,15,45). Longer race times likely correlate with increased water consumption and increased sodium losses (10,12,46). For example, participants who developed hyponatremia in the 1998 and 1999 San Diego Marathons had an average finishing time of 5 h and 38 min, and many of these individuals admitted to drinking as much fluid as possible during and after the event (12).…”

Section: Risk Factorsmentioning

confidence: 99%

Exercise-Associated Hyponatremia

Rosner

Kirven

2007

Clinical Journal of the American Society of Nephrology

170

165

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Exercise-associated hyponatremia has been described after sustained physical exertion during marathons, triathlons, and other endurance athletic events. As these events have become more popular, the incidence of serious hyponatremia has increased and associated fatalities have occurred. The pathogenesis of this condition remains incompletely understood but largely depends on excessive water intake. Furthermore, hormonal (especially abnormalities in arginine vasopressin secretion) and renal abnormalities in water handling that predispose individuals to the development of severe, life-threatening hyponatremia may be present. This review focuses on the epidemiology, pathogenesis, and therapy of exercise-associated hyponatremia.

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“…17,18 In triathletes, serum arginine vasopressin concentration was appropriately depressed in overhydrated hyponatraemic subjects. 19 Such endocrine studies were impossible in the field hospital.…”

Section: Renal Function and Hormonal Profile In Marathon Runnersmentioning

confidence: 99%

Iraq: the environmental challenge to HM Land Forces

Booth

2008

Clinical Medicine

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-In 2003, occasional military patients with hyponatraemia, hypokalaemia and alkalosis were encountered in Iraq. Development of central pontine myelinolysis in one patient indicated treatment should be cautious. Two years later, heat illness continued to occur during the very hot summer months and 23 cases were admitted to a British military field hospital near Basra, Iraq. Incidence was <0.15% of deployed personnel per summer month. Serum sodium and potassium concentrations were directly (r=0.66, p=0.0002) and serum sodium and bicarbonate concentrations inversely (r=-0.64, p=0.002) correlated. The magnitude of these changes was unrelated to the glomerular filtered load of sodium. While blood pressure was undiminished, estimated glomerular filtration rate was reduced. These electrolyte changes were compatible with secondary hyperaldosteronism but field conditions constrained further investigation. Hyponatraemia was probably due to salt deficiency rather than overhydration. In some military personnel summer salt supplementation could be essential during operations in hot countries.

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Exercise-Induced Hyponatremia in Ultradistance Triathletes Is Caused By Inappropriate Fluid Retention

Abstract: Triathletes with symptomatic hyponatremia following very prolonged exercise have abnormal fluid retention including an increased extracellular volume, but without evidence for large sodium losses. Such fluid retention is not associated with elevated plasma AVP concentrations.

Cited by 101 publications

References 21 publications

Effect of a Multistage Ultraendurance Triathlon on Aldosterone, Vasopressin, Extracellular Water and Urine Electrolytes

Effect of a Multistage Ultraendurance Triathlon on Aldosterone, Vasopressin, Extracellular Water and Urine Electrolytes

Exercise-Associated Hyponatremia

Iraq: the environmental challenge to HM Land Forces

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