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  1. Article: Exercise-Associated Hyponatremia in Marathon Runners.

    Klingert, Mark / Nikolaidis, Pantelis T / Weiss, Katja / Thuany, Mabliny / Chlíbková, Daniela / Knechtle, Beat

    Journal of clinical medicine

    2022  Volume 11, Issue 22

    Abstract: Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al ... to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is ... dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered ...

    Abstract Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.
    Language English
    Publishing date 2022-11-16
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11226775
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: EXERCISE-ASSOCIATED HYPONATREMIA.

    Rosner, Mitchell H

    Transactions of the American Clinical and Climatological Association

    2019  Volume 130, Page(s) 76–87

    Abstract: Exercise-associated hyponatremia (EAH) is defined by an acute fall in the serum or plasma sodium ...

    Abstract Exercise-associated hyponatremia (EAH) is defined by an acute fall in the serum or plasma sodium concentration to below 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. EAH has been reported in nearly every form of endurance activity and has a common pathogenic feature of excessive water intake which is usually coupled with elevated vasopressin levels. Symptomatic EAH is uncommon but can be a cause of mortality in otherwise healthy adults and children. Rapid recognition and appropriate treatment with hypertonic saline are essential to maximizing outcomes and preventing death.
    MeSH term(s) Arginine Vasopressin/metabolism ; Asymptomatic Diseases ; Drinking Behavior ; Drinking Water ; Exercise/physiology ; Fluid Therapy ; Humans ; Hyponatremia/epidemiology ; Hyponatremia/metabolism ; Hyponatremia/physiopathology ; Hyponatremia/therapy ; Saline Solution, Hypertonic/therapeutic use
    Chemical Substances Drinking Water ; Saline Solution, Hypertonic ; Arginine Vasopressin (113-79-1)
    Language English
    Publishing date 2019-09-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603823-2
    ISSN 0065-7778
    ISSN 0065-7778
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Exercise-Associated Hyponatremia.

    Hew-Butler, Tamara

    Frontiers of hormone research

    2019  Volume 52, Page(s) 178–189

    Abstract: Exercise-associated hyponatremia (EAH) refers to below-normal serum sodium concentrations [Na+ ... symptomatic EAH. Cases of hyponatremia are mostly reported after endurance sports, but are also observed after ... that develop during exercise. The pathogenesis of EAH is best described as a spectrum ranging between profound ...

    Abstract Exercise-associated hyponatremia (EAH) refers to below-normal serum sodium concentrations [Na+] that develop during exercise. The pathogenesis of EAH is best described as a spectrum ranging between profound polydipsia to modest sweat sodium losses with hypovolemia and relative dilution. Non-osmotic arginine vasopressin (AVP) remains the unifying pathogenic stimulus to abnormal renal water retention in acute symptomatic EAH. Cases of hyponatremia are mostly reported after endurance sports, but are also observed after shorter duration events and in team sport athletes. The signs and symptoms of EAH are vague, and include bloating, vomiting, headache, and altered mental status. A diagnosis of EAH can only be confirmed by a blood test, whereas signs/symptoms guide the most appropriate treatment strategy. Mild-to-moderate EAH (without encephalopathy) can be treated with either fluid restriction or an oral bolus of a hypertonic saline solution. Severe EAH (with encephalopathy) is a life-threatening emergency and should be urgently treated with intravenous 100 mL boluses of 3% saline until the resolution of encephalopathy symptoms. The prevention of EAH is evolutionarily rooted in preventing overdrinking during exercise. Drinking according to the dictates of thirst is the most individualized strategy to prevent life-threatening dysnatremia during exercise, regardless of sport.
    MeSH term(s) Brain Diseases/etiology ; Brain Diseases/therapy ; Exercise ; Humans ; Hyponatremia/complications ; Hyponatremia/etiology ; Hyponatremia/physiopathology ; Hyponatremia/therapy
    Language English
    Publishing date 2019-01-15
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 1662-3762 ; 0301-3073
    ISSN (online) 1662-3762
    ISSN 0301-3073
    DOI 10.1159/000493247
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Broca's aphasia as a clinical manifestation of exercise-associated hyponatremia in a non-athlete male.

    Zagaliotis, A / Filippatos, T D / Ioannou, P

    Hippokratia

    2022  Volume 24, Issue 4, Page(s) 196

    Language English
    Publishing date 2022-01-06
    Publishing country Greece
    Document type Journal Article
    ZDB-ID 2491943-3
    ISSN 1790-8019 ; 1108-4189
    ISSN (online) 1790-8019
    ISSN 1108-4189
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Exercise-Associated Hyponatremia in the Grand Canyon: Preventing Fatalities through Early Recognition, Timely Therapy, and Education.

    Rosner, Mitchell H / Myers, Tom / Bennett, Brad / Lipman, Grant / Hew-Butler, Tamara

    Clinical journal of the American Society of Nephrology : CJASN

    2023  

    Language English
    Publishing date 2023-12-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.0000000000000402
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Clinical presentation of exercise-associated hyponatremia in male and female IRONMAN® triathletes over three decades.

    Johnson, Kasey B / Connolly, Christopher P / Cho, Stephanie P / Miller, Thomas K / Sallis, Robert E / Hiller, W Douglas B

    Scandinavian journal of medicine & science in sports

    2023  Volume 33, Issue 9, Page(s) 1841–1849

    Abstract: Purpose: Exercise-associated hyponatremia (EAH) is common in ultra-endurance events and severe ... the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant ... differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is ...

    Abstract Purpose: Exercise-associated hyponatremia (EAH) is common in ultra-endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra-endurance competitions.
    Methods: Medical records with sodium concentrations (n = 3138) from the IRONMAN® World Championships over the timeframe of 1989-2019 were reviewed for both male (n = 2253) and female (n = 885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations.
    Results: When comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight.
    Conclusions: Altered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life-threatening complications.
    MeSH term(s) Humans ; Male ; Female ; Hyponatremia/etiology ; Muscle Cramp/etiology ; Physical Endurance/physiology ; Exercise/physiology ; Sodium
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2023-05-19
    Publishing country Denmark
    Document type Journal Article
    ZDB-ID 1077418-x
    ISSN 1600-0838 ; 0905-7188
    ISSN (online) 1600-0838
    ISSN 0905-7188
    DOI 10.1111/sms.14401
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Exercise-Associated Hyponatremia: Updated Guidelines from the Wilderness Medical Society.

    Jonas, Christopher E / Arnold, Michael J

    American family physician

    2021  Volume 103, Issue 4, Page(s) 252–253

    MeSH term(s) Exercise ; Humans ; Hyponatremia/diagnosis ; Hyponatremia/etiology ; Hyponatremia/therapy ; Societies, Medical
    Language English
    Publishing date 2021-02-15
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 412694-4
    ISSN 1532-0650 ; 0002-838X ; 0572-3612
    ISSN (online) 1532-0650
    ISSN 0002-838X ; 0572-3612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A review of risk factors and prevention strategies for exercise associated hyponatremia.

    Seal, Adam D / Kavouras, Stavros A

    Autonomic neuroscience : basic & clinical

    2021  Volume 238, Page(s) 102930

    Abstract: Exercise-associated hyponatremia (EAH) is defined as a serum sodium concentration under 135 mmol·L ...

    Abstract Exercise-associated hyponatremia (EAH) is defined as a serum sodium concentration under 135 mmol·L
    Language English
    Publishing date 2021-12-21
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2020105-9
    ISSN 1872-7484 ; 1566-0702
    ISSN (online) 1872-7484
    ISSN 1566-0702
    DOI 10.1016/j.autneu.2021.102930
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon.

    Khodaee, Morteza / Saeedi, Anahita / Harris-Spinks, Christine / Hew-Butler, Tamara

    Physical activity and nutrition

    2021  Volume 25, Issue 3, Page(s) 16–22

    Abstract: Purpose: Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes ... not associated with the development of EAH. Lower postrace [Na+] levels were associated with higher ...

    Abstract Purpose: Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes at low altitudes. The incidence of EAH during ultramarathons at high altitudes warrants further investigation. This prospective observational study was conducted on the participants of the Leadville Trail 100 run, a 161- km race held at a high altitude (2,800 m-3,840 m).
    Methods: Venous blood samples were collected before and immediately after the race. The participants completed an electronic survey after the race. Our main outcome measure was the post-race serum sodium ([Na+]) level.
    Results: Of the 672 athletes who started the race, 351 (52%) successfully completed the event within the 30- hour cut-off. Post-race blood samples were collected from 84 runners (66 finishers). Both pre- and post-race blood samples were collected from 37 participants. Twenty percent of the post-race participants had EAH. Only one post-race participant had a [Na+] level of <130 mmol/L. All participants with EAH were asymptomatic. One participant had an abnormal pre-race [Na+] level (134 mmol/L). Female participants had a significantly higher rate of EAH than male participants (40% vs. 16%; p=0.039). Age, body mass index, weight changes, race completion status, nonsteroidal anti-inflammatory drug use, and urine specific gravity were not associated with the development of EAH. Lower postrace [Na+] levels were associated with higher serum creatine kinase values (R2=0.1, p<0.005).
    Conclusion: High altitude (3,840 m peak) does not appear to enhance the incidence of EAH after an ultramarathon footrace. This suggests that ambient temperature (low temperatures reduce risk), sex (female predilection), endurance running, and overhydration are more prominent risk factors for EAH than high altitude.
    Language English
    Publishing date 2021-09-30
    Publishing country Korea (South)
    Document type Journal Article
    ISSN 2733-7545
    ISSN (online) 2733-7545
    DOI 10.20463/pan.2021.0016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Exercise-Associated Hyponatremia in a Lactating Female.

    Bailowitz, Zach / Grams, Raymond / Teeple, David / Hew-Butler, Tamara

    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

    2017  Volume 27, Issue 4, Page(s) e55–e57

    Abstract: ... induced oxytocin release may have on sustained antidiuresis and dilutional exercise-associated ... hyponatremia (EAH). This would be the first report documenting EAH in a lactating woman, which may highlight ... Na]) was 126 mmol/L. In the 24 hours before admission, she exercised vigorously for 120 minutes ...

    Abstract A 37-year-old woman presented to the emergency department with severe headache, which quickly progressed to altered mental status and seizure activity in hospital. Her initial serum sodium concentration ([Na]) was 126 mmol/L. In the 24 hours before admission, she exercised vigorously for 120 minutes (interval training plus yoga) and also consumed more than 4 liters of fluid during that time to both stay hydrated and facilitate milk production because she was actively nursing 2 children. Her serum [Na] and altered mental status corrected slowly over the next 48 hours with furosemide, hypertonic saline, and fluid restriction. This case is unique because it discusses the possible pathogenic role that lactation-induced oxytocin release may have on sustained antidiuresis and dilutional exercise-associated hyponatremia (EAH). This would be the first report documenting EAH in a lactating woman, which may highlight an underrecognized risk factor for physically active women who are concurrently breast-feeding.
    MeSH term(s) Adult ; Exercise ; Female ; Humans ; Hyponatremia/diagnosis ; Hyponatremia/therapy ; Lactation ; Saline Solution, Hypertonic ; Sodium/blood
    Chemical Substances Saline Solution, Hypertonic ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2017-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1062530-6
    ISSN 1536-3724 ; 1050-642X
    ISSN (online) 1536-3724
    ISSN 1050-642X
    DOI 10.1097/JSM.0000000000000344
    Database MEDical Literature Analysis and Retrieval System OnLINE

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