Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons

Brian J. Krabak, Grant S. Lipman, Brandee L Waite, Sean D. Rundell

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. Methods: This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. Results: The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. Conclusions: The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

Original languageEnglish (US)
JournalWilderness and Environmental Medicine
DOIs
StateAccepted/In press - 2017

Fingerprint

Hypernatremia
Hyponatremia
Exercise
Incidence
Body Weight
Weight Gain
Jordan
Observational Studies
Cohort Studies
Sodium
Weights and Measures

Keywords

  • Hydration
  • Hypernatremia
  • Hyponatremia
  • Ultramarathon running

ASJC Scopus subject areas

  • Emergency Medicine
  • Public Health, Environmental and Occupational Health

Cite this

Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons. / Krabak, Brian J.; Lipman, Grant S.; Waite, Brandee L; Rundell, Sean D.

In: Wilderness and Environmental Medicine, 2017.

Research output: Contribution to journalArticle

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title = "Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons",
abstract = "Objective: Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. Methods: This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. Results: The prevalence of EAH per stage was 1.6{\%} (S1), 4.8{\%} (S3), and 10.1{\%} (S5) with a cumulative incidence of 14.8{\%}. Per-stage prevalence of hypernatremia was 35.2{\%} (S1), 20.2{\%} (S3), and 19.3{\%} (S5) with a cumulative incidence of 52.3{\%}. Runners became more dehydrated (weight change <-3{\%}) throughout the race (S1=22.1{\%}; S3=51.2{\%}; S5=53.5{\%}). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75{\%} vs 5{\%}, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. Conclusions: The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.",
keywords = "Hydration, Hypernatremia, Hyponatremia, Ultramarathon running",
author = "Krabak, {Brian J.} and Lipman, {Grant S.} and Waite, {Brandee L} and Rundell, {Sean D.}",
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T1 - Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons

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AU - Lipman, Grant S.

AU - Waite, Brandee L

AU - Rundell, Sean D.

PY - 2017

Y1 - 2017

N2 - Objective: Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. Methods: This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. Results: The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. Conclusions: The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

AB - Objective: Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. Methods: This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. Results: The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. Conclusions: The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

KW - Hydration

KW - Hypernatremia

KW - Hyponatremia

KW - Ultramarathon running

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