Abstract
IntroductionHyponatremia often occurs during the practice of endurance sports. We evaluated the impact on hyponatremia of the hydration recommendations of the Third International Exercise-Associated Hyponatremia Consensus Development Conference 2015 (3IE-AHCD) during the 2017 Gran Trail de Peñalara marathon (GTP) and the Vitoria Gasteiz Ironman triathlon (VGI).MethodsProspective study of GTP and VGI athletes participating in four information sessions in the months prior to the events, to explain that hydration should only be according to their level of thirst, per the recommendations of the 3IE-AHCD. Consenting event finishers were included in final analysis. Pre- and post-race anthropometric and biochemical parameters were compared.ResultsThirty-six GTP (33 male) and 94 VGI (88 male) finishers were evaluated. GTP race median fluid intake was 800 ml/h, with 900 ml/h in the VGI race. 83.3% GTPfin and 77.6% VGIfin remained eunatremic (blood sodium 135–145 mmol/L). Only 1/36 GTP and 1/94 VGI participant finished in hyponatremia, both with a sodium level of 134 mmol/L. Fourteen percent of GTP, and 21.2% of VGI participants finished in hypernatremia, with no increase in race completion times. No participating athlete required medical attention, except for musculoskeletal complaints. Pro-BNP and Copeptin levels rose significantly. Changes in copeptin levels did not correlate with changes in plasma osmolality, nor total body water content in impedance analysis.ConclusionsRecommending that athletes' fluid intake in endurance events be a function of their thirst almost entirely prevented development of hyponatremia, without induction of clinically significant hypernatremia, or a negative repercussion on race completion times.
Highlights
Hyponatremia often occurs during the practice of endurance sports
Athletes taking part in long-distance events are often worried that their fluid intake (FI) will be insufficient, inducing them to drink in excess [5]
Data for this prospective study were collected during the Gran Trail de Peñalara marathon (GTP) and Vitoria Gasteiz Ironman triathlon (VGI) competitions held on June 23rd and July 9th 2017, respectively
Summary
Hyponatremia often occurs during the practice of endurance sports. Hyponatremia often occurs during physical exercise, during the practice of endurance sports [1–4]. One of the postulated causes is an excess consumption of fluids. Athletes taking part in long-distance events are often worried that their fluid intake (FI) will be insufficient, inducing them to drink in excess [5]. The problem can be exacerbated by a reduction in the urine water excretion due to exercise-induced non-osmotic secretion of the antidiuretic hormone, arginine vasopressin (AVP). Exercise-induced hyponatremia is one of the most important medical problems encountered during marathons, ultra-marathons and Ironman distance triathlons, since it can be lethal. Incidences ranging from 15 to 30% have been reported, and sodium levels below 120 mmol/L found in ∼1% of athletes [1, 2, 6]
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