title: Exercise-induced hyponatremia in ultradistance triathletes is caused by inappropriate fluid retention.
abstract: OBJECTIVE
  To study fluid and sodium balance during overnight recovery following an ultradistance triathlon in hyponatremic athletes compared with normonatremic controls. CASE CONTROL STUDY: Prospective descriptive study.
  
  
  METHODS
  1997 New Zealand Ironman Triathlon (3.8 Km swim, 180 Km cycle, 42.2 Km run).
  
  
  METHODS
  Seven athletes ("subjects") hospitalized with hyponatremia (median sodium [Na] = 128 mmol L(-1)). Data were compared with measurements from 11 normonatremic race finishers ("controls") (median sodium = 141 mmol L(-1)).
  
  
  METHODS
  None.
  
  
  METHODS
  Athletes were weighed prior to, immediately after, and on the morning after, the race. Blood was drawn for sodium, hemoglobin, and hematocrit immediately after the race and the following morning. Plasma concentrations of arginine-vasopressin (AVP) were also measured post race.
  
  
  RESULTS
  Subjects were significantly smaller than controls (62.5 vs. 72.0 Kg) and lost less weight during the race than controls (median -0.5% vs. -3.9%, p = 0.002) but more weight than controls during recovery (-4.4% vs. -0.8%, p 0.002). Subjects excreted a median fluid excess during recovery (1,346 ml): controls had a median fluid deficit (521 ml) (p = 0.009). Estimated median sodium deficit was the same in subjects and controls (88 vs. 38 mmol L(-1), p = 0.25). Median AVP was significantly lower in subjects than in controls. Plasma volume fell during recovery in subjects (-5.9%, p = 0.016) but rose in controls (0.76%, p = NS).
  
  
  CONCLUSIONS
  Triathletes with symptomatic hyponatremia following very prolonged exercise have abnormal fluid retention including an increased extracellular volume, but without evidence for large sodium losses. Such fluid retention is not associated with elevated plasma AVP concentrations.
authors.affiliation: Department of General Practice and Primary Care, University of Auckland, New Zealand. dalespeedy@e3.net.nz
authors.forename: D B
authors.initials: DB
authors.lastname: Speedy
authors.forename: I R
authors.initials: IR
authors.lastname: Rogers
authors.forename: T D
authors.initials: TD
authors.lastname: Noakes
authors.forename: S
authors.initials: S
authors.lastname: Wright
authors.forename: J M
authors.initials: JM
authors.lastname: Thompson
authors.forename: R
authors.initials: R
authors.lastname: Campbell
authors.forename: I
authors.initials: I
authors.lastname: Hellemans
authors.forename: N E
authors.initials: NE
authors.lastname: Kimber
authors.forename: D R
authors.initials: DR
authors.lastname: Boswell
authors.forename: J A
authors.initials: JA
authors.lastname: Kuttner
authors.forename: S
authors.initials: S
authors.lastname: Safih
mesh_terms: D000328:Adult; D001642:Bicycling / Q000502:physiology*; D016022:Case-Control Studies; D004327:Drinking Behavior; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012420:Running / Q000502:physiology*; D012964:Sodium / Q000097:blood; D018709:Statistics, Nonparametric; D013550:Swimming / Q000502:physiology*; D014883:Water-Electrolyte Imbalance / Q000503:physiopathology*
chemical_list: D012964:Sodium