Evaluation of renal function and fluid homeostasis during recovery from exercise-induced hyponatremia

Irving, Robert A.; Noakes, Timothy D.; Buck, Robert W.; Smit, Richard van Zyl; Raine, E.V.; Godlonton, J. D.; Norman, Robert J.

doi:10.1152/jappl.1991.70.1.342

Cited by 136 publications

(140 citation statements)

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“…A etiologia deste distúrbio ainda é controversa. Contudo, há algumas considerações mais plausíveis como a sobrecarga da ingestão hídrica com reposição insuficiente de sódio, atividade inapropriada do hormônio antidiurético (12)(13)(14) , seqüestro de sódio para o intestino (terceiro espaço), perda de sódio excessiva no suor, insuficiência renal em eliminar o excesso de líquido (15) , associado ou não ao uso de antiinflamatórios não hormonais (38) . Dentre todas essas possibilidades o excesso de ingestão hídrica associada ou não a outros fatores parece ser a principal causa da hiponatremia em atletas de triatlon Ironman.…”

Section: Discussionunclassified

“…Porém, o grau de desidratação é superestimado quando calculado unicamente pela diferença de peso corporal pré e pós prova. As alterações de peso corporal de um atleta de triatlon Ironman representam uma somatória de perdas hídricas e de fontes não hídricas, provenientes da oxidação da gordura, carboidratos e água contida no interior do glicogênio (7,13,(17)(18)(19)(20)(21) . Rogers sugere que a perda de 2,0kg sejam provenientes de fontes não hídricas (7) .…”

Section: Discussionunclassified

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Alterações hidroeletrolíticas agudas ocorridas no Triatlon Ironman Brasil

Mara

Lemos

Brochi

et al. 2007

Rev Bras Med Esporte

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ARTIGO ORIGINALPalavras-chave: Hiponatremia. Desidratação. Superhidratação. Potássio. Keywords:Hyponatremia. Dehydration. Superhydration. Potassium. RESUMOO Triatlon Ironman caracteriza-se por ser uma atividade de resistência constituída por 3,8km de natação, 180km de ciclismo e 42,2km de corrida, no qual o atleta exercita-se, em média, por cerca de 13 horas. Neste contexto, o atleta exposto a tal carga de esforço e adversidades ambientais, experimenta alterações orgâ-nicas agudas em seus sistemas biológicos, incluindo os distúr-bios hidroeletrolíticos. O objetivo deste estudo é descrever as alterações hídricas e eletrolíticas encontradas em atletas de triatlon Ironman. De 2002 a 2005 foram avaliados 109 atletas voluntários antes e imediatamente após as provas realizadas em Florianópo-lis-SC Brasil, com análise sanguínea dos eletrólitos sódio, e potás-sio, e medida de massa corporal. Os dados do sódio sérico de 89 atletas foram correlacionados com o grau de desidratação e modificações percentuais de peso corporal. Dados de 77 atletas, quanto ao potássio sérico, foram avaliados isoladamente de forma descritiva. Seis atletas (6,7%) apresentaram-se euhidratados ou superhidratados ao final da prova, 50 atletas desidrataram de 0 a 3% (56,2%), 29 de 3 a 6% (32,6%) e 4 atletas (4,5%) desidrataram mais que 6%. Houve uma tendência a ocorrer hiponatremia entre aqueles que desidrataram menos ou ganharam peso. O potássio teve um comportamento dentro dos limites da normalidade em toda amostra. Conclui-se que os distúrbios hidroeletrolíticos (hiponatremia e desidratação) são incidentes nesta modalidade esportiva, sendo a superhidratação a etiologia provável da hiponatremia denotada pelo ganho ou perdas discretas de peso. ABSTRACT Acute hydroelectrolytic changes occurred in the Brazilian Ironman TriathlonThe Ironman Triathlon is characterized for being an endurance activity consisting of 3.8 km of swimming, 180 km of cycling and 42.2 km of running, in which the athlete exercises an average of about 13 hours. In this context, the athlete exposed to such load of effort and environmental adversities, experiences acute organic alterations in his biological systems, including hydroelectrolytic disturbs. The objective of this study is to describe the hydric and electrolytic alterations found in Ironman triathlon athletes. From years 2002 to 2005, 109 volunteer athletes have been evaluated before and immediately after the events which took place in Florianópolis-SC Brazil, with blood analysis of sodium and potassium electrolytes, and body mass measurement. Sodium serum data from 89 athletes have been correlated with the degree of dehydration and percentage alterations of body weight. Data of 77 athletes concerning the serum potassium were separately evaluated in a descriptive way. Six athletes (6.7%) were euhydrated or superhydrated at the end of the test; 50 athletes were dehydrated from 0 to 3% (56.2%); 29 from 3 to 6 % (32.6%) and 4 athletes (4.5%) were dehydrated more than 6%. There was a tendency to hyponatremia among those who ...

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Section: Discussionunclassified

Alterações hidroeletrolíticas agudas ocorridas no Triatlon Ironman Brasil

Mara

Lemos

Brochi

et al. 2007

Rev Bras Med Esporte

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“…33 The change in serum sodium concentration after endurance exercise is inversely proportional to the change in body weight, and the athletes with EAH tended to gain weight during the exercise. 34 In marathon runners, low body mass index, race time exceeding 4 hours, consumption of fluids every mile, following advice to "drink as much as possible" during the race, and greater frequency of urination during the race have all been associated with EAH; in some but not all studies, female sex and the use of nonsteroidal anti-inflammatory drugs also were risk factors.…”

Section: Eahmentioning

confidence: 99%

“…EAH can be severe and life threatening as a result of cerebral edema and noncardiogenic pulmonary edema. 33,94 Prevention is paramount. Guidelines for appropriate fluid ingestion during marathons are available.…”

Section: Siadhmentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

519

498

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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“…The presence of acute kidney injury (AKI) in athletes is a well-researched topic in multiple populations: healthy marathon race finishers [2][3], marathon racers seeking medical care [4][5], and ultramarathon race participants [6][7]. Renal dysfunction during endurance events is thought to be due to a multifactorial combination of dehydration, injury from muscle breakdown, heat stress, and the use of non-steroidal anti-inflammatory drugs (NSAIDs), although acute renal failure is rare in this population [8].…”

Section: Introductionmentioning

confidence: 99%