Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015

Abstract

The third International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California in February 2015 with a panel of 17 international experts. The delegates represented 4 countries and 9 medical and scientific sub-specialties pertaining to athletic training, exercise physiology, sports medicine, water/sodium metabolism, and body fluid homeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus Statement. 1 This document serves to replace the second International EAH Consensus Development Conference Statement and launch an educational campaign designed to address the morbidity and mortality associated with a preventable and treatable fluid imbalance. The following statement is a summary of the data synthesized by the 2015 EAH Consensus Panel and represents an evolution of the most current knowledge on EAH. This document will summarize the most current information on the prevalence, etiology, diagnosis, treatment and prevention of EAH for medical personnel, athletes, athletic trainers, and the greater public. The EAH Consensus Panel strove to clearly articulate what we agreed upon, did not agree upon, and did not know, including minority viewpoints that were supported by clinical experience and experimental data. Further updates will be necessary to both: (1) remain current with our understanding and (2) critically assess the effectiveness of our present recommendations. Suggestions for future research and educational strategies to reduce the incidence and prevalence of EAH are provided at the end of the document as well as areas of controversy that remain in this topic.

Thermal stress, human performance, and physical employment standards

“…Workers and medical personnel should, however, be alerted to the potential dangers of exercise-associated hyponatremia due to overdrinking during exercise in hot and humid environments (Lee et al 2011). Exercise-associated hyponatremia is defined as having a plasma sodium concentration below 135 mmol·L −1 within 24 h of physical activity (Hew-Butler et al 2015). It is noteworthy that externally advocated hydration policies (especially based on change in body mass with exercise in healthy individuals) have limited merit and are extrapolated and imposed too widely upon society at the expense of autonomy (Cotter et al 2014).…”

Pre-race characteristics and race performance in hyponatremic and normonatremic finishers of Czech ultra-races

“…This was an increase from previous research on this population in the Czech Republic in 2012 (5.7% of the 53 finishers) (Chlíbková, Knechtle, Rosemann, Žákovská, & Tomášková, 2014). It is important to examine the risk factors for EAH (Bennett et al, 2013;Hew-Butler et al, 2015;. Risk factors such as overdrinking water, sport drinks, and other hypotonic beverages; weight gain during race, race fluid intake of finishers and pre and during a race habits were investigated in detail in our recent publications (Chlíbková et al, 2015;Chlíbková et al, 2014;Chlíbková, Rosemann, Posch, Matoušek, & Knechtle, 2016).…”

“…It is defined by a serum, plasma or blood sodium [Na + ] concentration below 135 mmol/L (Hew-Butler et al, 2008). Athletes with symptomatic EAH can present with lightheadedness and nausea, headache, vomiting, altered mental state resulting from cerebral edema or noncardiogenic pulmonary edema (Hew-Butler et al, 2015). The major clinical relevance of asymptomatic 2015).…”

“…Exercise-associated hyponatremia (EAH) is used to describe hyponatremia occurring during or up to 24 hours after physical activity (Hew-Butler et al, 2015). It is defined by a serum, plasma or blood sodium [Na + ] concentration below 135 mmol/L (Hew-Butler et al, 2008).…”

“…Despite an increasing number of participants and events, there is limited information relating to the EAH in this country. Racers, event staff and emergency medical service personnel should be educated about proper recognition and treatment of EAH (Bennett, Hew-Butler, Hoffman, Rogers, & Rosner, 2013;Hew-Butler et al, 2015;Wegelin & Hoffman, 2011). Recently, it was reported that in 2012/2013 11.5% of 113 ultra-endurance athletes from a number of different sports developed post-race hyponatremia (Chlíbková et al, 2015).…”