Rhabdomyolysis and exercise-associated hyponatremia in ultra-bikers and ultra-runners

Abstract

BackgroundExercise-associated hyponatremia (EAH), rhabdomyolysis and renal failure appear to be a unique problem in ultra-endurance racers.MethodsWe investigated the combined occurrence of EAH and rhabdomyolysis in seven different ultra-endurance races and disciplines (i.e. multi-stage mountain biking, 24-h mountain biking, 24-h ultra-running and 100-km ultra-running).ResultsTwo (15.4 %) ultra-runners (man and woman) from hyponatremic ultra-athletes (n = 13) and four (4 %) ultra-runners (four men) from the normonatremic group (n = 100) showed rhabdomyolysis following elevated blood creatine kinase (CK) levels > 10,000 U/L without the development of renal failure and the necessity of a medical treatment. Post-race creatine kinase, plasma and urine creatinine significantly increased, while plasma [Na+] and creatine clearance decreased in hyponatremic and normonatremic athletes, respectively. The percentage increase of CK was higher in the hyponatremic compared to the normonatremic group (P < 0.05). Post-race CK levels were higher in ultra-runners compared to mountain bikers (P < 0.01), in faster normonatremic (P < 0.05) and older and more experienced hyponatremic ultra-athletes (P < 0.05). In all finishers, pre-race plasma [K+] was related to post-race CK (P < 0.05).ConclusionsHyponatremic ultra-athletes tended to develop exercise-induced rhabdomyolysis more frequently than normonatremic ultra-athletes. Ultra-runners tended to develop rhabdomyolysis more frequently than mountain bikers. We found no association between post-race plasma [Na+] and CK concentration in both hypo- and normonatremic ultra-athletes.

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

“…In summary, the primary etiology and pathophysiological mechanism underlying EAH in the present ultra-endurance athletes group was presumably overconsumption of hypotonic fluids in likely combination with non-osmotic arginin vasopressin secretion as we stated in our previous studies (Chlíbková et al, 2014;Chlíbková et al, 2015;Chlíbková et al, 2016).…”

“…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). 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). Little is known; however, about selected pre-race characteristics and risk factors such as training experience, gender, age, pre-race BMI and race performance between those ultra-athletes developing EAH and those not developing EAH.…”

Description of Three Female 24-h Ultra-Endurance Race Winners in Various Weather Conditions and Disciplines

“…According to the Cairns and Hew-Butler study (11), transient hypovolemic EAH preceded significantly higher elevations in CK in their limited sample size of runners during an ultraendurance race. In our recent study (14), we documented 6% cases of EAH with rhabdomyolysis in ultra-endurance runners (five men and one woman) and 0% in ultra-endurance mountain bikers. Fellmann et al (20) demonstrated that a 24-h running race caused more muscular lesions than a triathlon, where ultra-endurance cycling was a part of the event.…”

“…A 46-year-old female mountain biker won the "Czech Championship 24-h mountain biking race" in Jihlava (Case 3), a race with the highest number of participants from the series of 24-h mountain bike races held in the Czech Republic (14). The ultraendurance mountain bikers started at 12 p.m. on 18 May 2013 and finished at 12 p.m. on 19 May 2013.…”