ArticleProceedings of the National Academy of Sciences of the United States of America2005
Three independent biological mechanisms cause exercise-associated hyponatremia: evidence from 2,135 weighed competitive athletic performances.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers.
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Who cites it
90 citing papers in PubMed, 329 citations in OpenAlex.
- Efficacy of Ingesting an Oral Rehydration Solution after Exercise on Fluid Balance and Endurance Performance.Nutrients · 2020Trial
- Carbohydrate supplementation stabilises plasma sodium during training with high intensity.European journal of applied physiology · 2016Trial
- Trial
- Higher prevalence of exercise-associated hyponatremia in female than in male open-water ultra-endurance swimmers: the 'Marathon-Swim' in Lake Zurich.European journal of applied physiology · 2012Trial
- Fluid intake and changes in limb volumes in male ultra-marathoners: does fluid overload lead to peripheral oedema?European journal of applied physiology · 2012Trial
- Low prevalence of exercise-associated hyponatremia in male 100 km ultra-marathon runners in Switzerland.European journal of applied physiology · 2011Trial
- Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon.British journal of sports medicine · 2006Trial
- Sodium replacement and plasma sodium drop during exercise in the heat when fluid intake matches fluid loss.Journal of athletic trainingTrial
- Thermoregulation and Hydration Dynamics in a 160-km Ultra-Endurance Race in a Tropical Environment: A Field Study on 80 Runners.Sports medicine (Auckland, N.Z.) · 2026Article
- Evaluation of an estimation equation for water turnover in male collegiate sprinters based on the doubly labeled water method.European journal of clinical nutrition · 2026Article
- Pathophysiology and treatment of exercise-associated hyponatremia.Journal of endocrinological investigation · 2026Review
- No hyponatremia despite continuous plasma sodium decline in female runners during a seven stage ultramarathon.Scientific reports · 2025Article
- Exercise-Associated Hyponatremia: Serum Sodium, Symptomatology, Severity, and Sport Specificity.Open access journal of sports medicine · 2025Review
- Urban Heat and Burden of Hyponatremia.JAMA network open · 2024Article
- Endocrine effects of heat exposure and relevance to climate change.Nature reviews. Endocrinology · 2024Review
- Exercise-Associated Hyponatremia in the Grand Canyon: Preventing Fatalities through Early Recognition, Timely Therapy, and Education.Clinical journal of the American Society of Nephrology : CJASN · 2024Article
- A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise.European journal of applied physiology · 2024Review
- Coconut Water: A Sports Drink Alternative?Sports (Basel, Switzerland) · 2023Article
- Review
- Seasonal Oxy-Inflammation and Hydration Status in Non-Elite Freeskiing Racer: A Pilot Study by Non-Invasive Analytic Method.International journal of environmental research and public health · 2023Article
30 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
To evaluate the role of fluid and Na+ balance in the development of exercise-associated hyponatremia (EAH), changes in serum Na+ concentrations ([Na+]) and in body weight were analyzed in 2,135 athletes in endurance events. Eighty-nine percent of athletes completed these events either euhydrated (39%) or with weight loss (50%) and with normal (80%) or elevated (13%) serum [Na+]. Of 231 (11%) athletes who gained weight during exercise, 70% were normonatremic or hypernatremic, 19% had a serum [Na+] between 129-135 mmol/liter, and 11% a serum [Na+] of <129 mmol/liter. Serum [Na+] after racing was a linear function with a negative slope of the body weight change during exercise. The final serum [Na+] in a subset of 18 subjects was predicted from the amount of Na+ that remained osmotically inactive at the completion of the trial. Weight gain consequent to excessive fluid consumption was the principal cause of a reduced serum [Na+] after exercise, yet most (70%) subjects who gained weight maintained or increased serum [Na+], requiring the addition of significant amounts of Na+ (>500 mmol) into an expanded volume of total body water. This Na+ likely originated from osmotically inactive, exchangeable stores. Thus, EAH occurs in athletes who (i) drink to excess during exercise, (ii) retain excess fluid because of inadequate suppression of antidiuretic hormone secretion, and (iii) osmotically inactivate circulating Na+ or fail to mobilize osmotically inactive sodium from internal stores. EAH can be prevented by insuring that athletes do not drink to excess during exercise, which has been known since 1985.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.