ArticleEuropean journal of applied physiology2016
Proof of concept: hypovolemic hyponatremia may precede and augment creatine kinase elevations during an ultramarathon.
Article in European journal of applied physiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Acute Kidney Injury and Hyponatremia in Ultra-Trail Racing: A Systematic Review.Medicina (Kaunas, Lithuania) · 2022Pooled it
- 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
- Observational Study of the Association between Hyponatremia and Rhabdomyolysis in Patients Presenting to Hospital.Journal of clinical medicine · 2022Article
- 768-km Multi-Stage Ultra-Trail Case Study-Muscle Damage, Biochemical Alterations and Strength Loss on Lower Limbs.International journal of environmental research and public health · 2022Article
- Extreme Ultra-Trail Race Induces Muscular Damage, Risk for Acute Kidney Injury and Hyponatremia: A Case Report.International journal of environmental research and public health · 2021Article
- The Consequences of Training and Competition to the Musculoskeletal System in Ultramarathon Runners: A Narrative Review.Frontiers in physiology · 2021Review
- Effect of mountain ultramarathon distance competition on biochemical variables, respiratory and lower-limb fatigue.PloS one · 2020Article
- Life-threatening heat-related illness with severe hyponatremia in an aluminum smelter worker.American journal of industrial medicine · 2019Article
- Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review.Medicina (Kaunas, Lithuania) · 2019Review
- Ad libitum water consumption prevents exercise-associated hyponatremia and protects against dehydration in soldiers performing a 40-km route-march.Military Medical Research · 2019Observational
- Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners.Frontiers in physiology · 2019Article
- Osmolality Selectively Offsets the Impact of Hyperthermia on Mouse Skeletal MuscleFrontiers in physiology · 2018Article
- Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury.Frontiers in physiology · 2018Article
- Physiology and Pathophysiology in Ultra-Marathon Running.Frontiers in physiology · 2018Review
- National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active.Journal of athletic training · 2017Article
- Exercise-Associated Hyponatremia: 2017 Update.Frontiers in medicine · 2017Review
- Hyponatraemia-induced rhabdomyolysis complicated by anuric acute kidney injury: a renal replacement conundrum.BMJ case reports · 2016Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIt is not known if exercise-associated hyponatremia (EAH) is a cause or consequence of exertional rhabdomyolysis (ER).We hypothesized that osmotic stress (EAH) coupled with mechanical stress (running) potentiated muscle cell breakdown (ER). This concept would be supported if a nadir in serum sodium concentration ([Na(+)]) temporally preceded peak creatine kinase levels (CK) during an ultramarathon run.
methodsFifteen participants ran ≥104 km and had blood drawn: prior to start; 53; 104 km; and 24-h post run. Serum [Na(+)], CK, urea, creatinine and estimated glomerular filtration rate (eGFR) were measured from serial blood samples. Two-way repeated-measures ANOVA was used to examine differences regarding both race distance and natremia status.
resultsTen of 15 participants demonstrated EAH (serum [Na(+)] <135 mmol/L) at least once during serial testing. Participants were categorized post hoc into one of three natremia groups based on lowest recorded [Na(+)]: (1) <129 mmol/L (n = 3; moderate EAH); (2) between 129 and 134 mmol/L (n = 7; mild EAH); and (3) >134 mmol/L (n = 5; normonatremia). Participants with lowest [Na(+)] demonstrated highest CK values at subsequent checkpoints. Significant natremia group differences noted at the 53 km point (p = 0.0002) for [Na(+)] while significant natremia group effect noted for CK seen at the 24-h post-finish testing point (p = 0.02). Significant natremia group effects noted for renal biomarkers, with the moderate EAH group documenting the lowest eGFR (p = 0.005), and highest serum urea (p = 0.0006) and creatinine (p < 0.0001) levels. Hyponatremic runners had lower post-race urine [Na(+)] than normonatremic runners (26 ± 15 vs. 89 ± 79 mmol/L; p = 0.03).
conclusionsPreliminary data support the possibility that transient hypovolemic EAH may precede and augment CK during an ultramarathon.
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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.