title: Risk factors for exercise-associated hyponatremia in non-elite marathon runners.
abstract: OBJECTIVE
  Describe risk factors for lower post-race [Na+] and exercise-associated hyponatremia (EAH) (serum [Na+]<135 mmol/L) during marathon running.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Houston Marathon 2000-2004.
  
  
  METHODS
  Ninety-six runners from EAH research projects.
  
  
  METHODS
  Observational.
  
  
  METHODS
  Pre-race and post-race measurements: serum [Na+], weight, and fluid ingestion.
  
  
  RESULTS
  Twenty-one runners (22%) met criteria for EAH, and 87% of subjects had lower post-race [Na+] compared to pre-race [Na+]. Lower post-race [Na+] and larger [Na+] decrease were related to lower pre-race [Na+], less weight loss during the race, and more fluid cups consumed. Increased fluid consumed correlated with slower finish time, male gender, and warmer temperature. Less weight loss correlated with lower pre-race weight, more fluid consumed, and slower finish time. Losing less than 0.75 kg increased the risk of becoming hyponatremic 7 fold (RR=7.0; CI 1.8 to 26.6) compared to those who lost more than 0.75 kg. Women consumed fluid at a significantly lower rate than men (P=0.04). Estimated mean fluid balance for women was positive and significantly higher than men's negative fluid balance (P<0.0001). Fluid balance became more positive as finish time increased and pre-race weight decreased.
  
  
  CONCLUSIONS
  Lighter and slower runners have more positive fluid balance. Losing>0.75 kg of body weight during a marathon is advisable in order to decrease the risk of EAH. Runners should measure their sweat rate and monitor weight changes as part of their fluid consumption plan.
authors.affiliation: Baylor College of Medicine, Houston, Texas 77030, USA. jchorley@bcm.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Chorley
authors.forename: John
authors.initials: J
authors.lastname: Cianca
authors.forename: Jon
authors.initials: J
authors.lastname: Divine
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019370:Observation; D005082:Physical Exertion / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D012420:Running / Q000502:physiology*; D013178:Sports Medicine; D013781:Texas