Exercise-Associated Hyponatremia

Abstract

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.

Effects of a 24-h naproxen dose on hydration and electrolyte measures during moderate-intensity cycling in the heat

“…In extreme cases, cell necrosis, interstitial nephritis, and renal failure may develop (Garella and Matarese 1984). Milder consequences, although they can also become severe, include electrolyte imbalance, edema, and hypertension (Cheng and Harris 2005;Rosner and Kirven 2007).…”

“…Another contributing factor for developing hyponatremia is an individual consuming hypotonic fluid in excess of fluid lost through sweat and respiration (Rosner and Kirven 2007). If combined with other factors that dilute P[Na + ], the individual can be at greater risk for hyponatremia.…”

“…The lack of P[Na + ] depletion is likely due to the short exercise duration. Exertional hyponatremia is typically associated with endurance exercise lasting longer than 3 h (Noakes et al 2005;Rosner and Kirven 2007), but has also occurred in football (Creamer and Hagedorn 2008;Blevins and Apel 2014;Stevens 2014). Our cycling session likely did not allow enough .…”

“…Less imperative in normal healthy individuals, PGs are critical in maintaining homeostasis during altered cardiovascular states (e.g., hypotension) or altered fluid regulation (e.g., hypovolemia and sodium imbalance) (Garella and Matarese 1984)-common conditions experienced during physical activity. Inhibiting PGs can perpetuate altered cardiovascular and renal function, potentially leading to serious fluid and electrolyte imbalances (e.g., hyponatremia and hypertension) or even acute renal failure (Garella and Matarese 1984;Rosner and Kirven 2007).…”

“…Existing literature on NSAIDs and fluid regulation during physical activity primarily includes observational and retrospective cases of exertional hyponatremia (plasma sodium concentration (P[Na + ]) < 135 mmol/L) (Almond et al 2005;Wharam et al 2006;Rosner and Kirven 2007). NSAIDs are thought to potentiate hyponatremia by decreasing urine production and increasing water retention, which dilutes P[Na + ] (Cheng and Harris 2005).…”