Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review.
cerebral edema
cold
cycling
heat
prolonged exercise
running
swimming
Journal
Medicina (Kaunas, Lithuania)
ISSN: 1648-9144
Titre abrégé: Medicina (Kaunas)
Pays: Switzerland
ID NLM: 9425208
Informations de publication
Date de publication:
26 Aug 2019
26 Aug 2019
Historique:
received:
28
04
2019
revised:
15
08
2019
accepted:
21
08
2019
entrez:
29
8
2019
pubmed:
29
8
2019
medline:
25
2
2020
Statut:
epublish
Résumé
Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).
Identifiants
pubmed: 31455034
pii: medicina55090537
doi: 10.3390/medicina55090537
pmc: PMC6780610
pii:
doi:
Substances chimiques
Sodium
9NEZ333N27
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Emerg Med Australas. 2007 Aug;19(4):377-8
pubmed: 17655643
Harefuah. 2004 May;143(5):342-7, 391
pubmed: 15190845
J Appl Physiol (1985). 1988 Jul;65(1):325-31
pubmed: 3403476
Br J Sports Med. 2008 Oct;42(10):796-501
pubmed: 18400876
Wilderness Environ Med. 2012 Jun;23(2):153-7
pubmed: 22656662
Clin J Sport Med. 2000 Apr;10(2):136-41
pubmed: 10798796
Med Sci Sports Exerc. 1991 Jul;23(7):811-7
pubmed: 1921673
Clin J Sport Med. 2006 Jan;16(1):72-3
pubmed: 16377980
Sports Health. 2013 Jul;5(4):334-6
pubmed: 24459549
Eur J Appl Physiol. 2012 Mar;112(3):1095-106
pubmed: 21748367
Eur J Appl Physiol Occup Physiol. 1999 Sep;80(4):353-9
pubmed: 10483806
Am J Kidney Dis. 1993 Feb;21(2):206-9
pubmed: 8430683
Am J Emerg Med. 1994 Jul;12(4):441-4
pubmed: 8031429
Case Rep Med. 2016;2016:8194160
pubmed: 27721832
Med Sci Sports Exerc. 2001 Sep;33(9):1434-42
pubmed: 11528329
Proc Natl Acad Sci U S A. 2005 Dec 20;102(51):18550-5
pubmed: 16344476
Semin Nephrol. 2009 May;29(3):271-81
pubmed: 19523574
Chin J Physiol. 2016 Jun 30;59(3):173-83
pubmed: 27188470
Am J Sports Med. 1991 Jul-Aug;19(4):389-91
pubmed: 1897655
Ann Intern Med. 2000 May 2;132(9):711-4
pubmed: 10787364
Br J Sports Med. 2006 Feb;40(2):98-105; discussion 98-105
pubmed: 16431994
Med Sci Sports Exerc. 2005 May;37(5):789-96
pubmed: 15870633
Clin J Sport Med. 2011 May;21(3):200-3
pubmed: 21519296
Int J Sports Physiol Perform. 2013 Sep;8(5):536-41
pubmed: 23412802
Clin J Sport Med. 2002 Nov;12(6):391-9
pubmed: 12466696
BMJ Case Rep. 2018 Mar 9;2018:null
pubmed: 29523608
Medicina (Kaunas). 2019 Mar 07;55(3):null
pubmed: 30866569
Eur J Appl Physiol. 2012 Mar;112(3):991-1003
pubmed: 21720884
Med Sci Sports Exerc. 2002 Feb;34(2):185-9
pubmed: 11828223
Am J Physiol Regul Integr Comp Physiol. 2011 Mar;300(3):R605-15
pubmed: 21228336
Clin J Sport Med. 2007 Nov;17(6):471-7
pubmed: 17993790
Clin J Sport Med. 2010 Jan;20(1):47-52
pubmed: 20051734
Sports Med. 2014 Aug;44(8):1055-69
pubmed: 24748459
Res Sports Med. 2013;21(2):164-75
pubmed: 23541103
Med Klin Intensivmed Notfmed. 2013 Apr;108(3):234-7
pubmed: 23381723
J Appl Physiol (1985). 1991 Jan;70(1):342-8
pubmed: 2010390
Appl Physiol Nutr Metab. 2013 Mar;38(3):286-91
pubmed: 23537020
Emerg Med (Fremantle). 2001 Mar;13(1):17-27
pubmed: 11476407
Horm Metab Res. 2011 Aug;43(9):646-52
pubmed: 21823061
Eur J Appl Physiol. 2016 Mar;116(3):647-55
pubmed: 26747653
J Appl Physiol (1985). 2009 Sep;107(3):864-72
pubmed: 19556454
Front Med (Lausanne). 2017 Mar 03;4:21
pubmed: 28316971
Med Sci Sports Exerc. 1989 Oct;21(5 Suppl):S219-21
pubmed: 2691834
J Int Soc Sports Nutr. 2012 Apr 03;9(1):11
pubmed: 22472466
JAMA. 1986 Feb 14;255(6):772-4
pubmed: 3944980
Med Sci Sports Exerc. 1985 Jun;17(3):370-5
pubmed: 4021781
Am J Clin Pathol. 2009 Sep;132(3):336-40
pubmed: 19687309
Int J Sport Nutr Exerc Metab. 2010 Oct;20(5):427-42
pubmed: 20975111
Clin J Sport Med. 2015 Sep;25(5):418-24
pubmed: 26340734
Clin J Sport Med. 1997 Jul;7(3):180-4
pubmed: 9262884
Curr Sports Med Rep. 2017 Sep/Oct;16(5):343-345
pubmed: 28902757
J Appl Physiol (1985). 1991 Dec;71(6):2518-27
pubmed: 1778952
Wilderness Environ Med. 2014 Dec;25(4 Suppl):S30-42
pubmed: 25498260
Phys Sportsmed. 2010 Dec;38(4):94-100
pubmed: 21150148
Med Sci Sports Exerc. 2015 Sep;47(9):1781-7
pubmed: 25551404
Med Sci Sports Exerc. 1994 Sep;26(9):1095-101
pubmed: 7808242
Med Sci Sports Exerc. 1995 Dec;27(12):1595-601
pubmed: 8614313
J Clin Med. 2014 Nov 12;3(4):1258-75
pubmed: 26237602
Phys Sportsmed. 2016 Nov;44(4):343-348
pubmed: 27548748
J Appl Physiol. 1976 Jan;40(1):6-11
pubmed: 1248983
Endocrine. 2017 Jan;55(1):311-319
pubmed: 27025948
Clin J Sport Med. 2008 Jul;18(4):344-9
pubmed: 18614886
J R Soc Med. 2006 Jul;99(7):363-7
pubmed: 16816267
Br J Sports Med. 2010 Jun;44(8):594-7
pubmed: 18628357
Clin J Sport Med. 2007 Jan;17(1):43-8
pubmed: 17304005
Mil Med. 2002 May;167(5):432-4
pubmed: 12053855
Clin J Sport Med. 2015 Jul;25(4):303-20
pubmed: 26102445
Clin J Sport Med. 2008 Sep;18(5):383-6
pubmed: 18806543
Front Physiol. 2019 Jan 11;9:1959
pubmed: 30687135
Clin J Sport Med. 2007 Jan;17(1):68-9
pubmed: 17304010
Front Physiol. 2018 Feb 12;9:91
pubmed: 29483882
J Emerg Nurs. 1997 Dec;23(6):586-90
pubmed: 9460397
J Biol Chem. 2011 Mar 25;286(12):10864-75
pubmed: 21135109
Lakartidningen. 2008 May 28-Jun 3;105(22):1650-2
pubmed: 18590004
J Strength Cond Res. 2014 Mar;28(3):807-13
pubmed: 23897018
Wilderness Environ Med. 2015 Mar;26(1):59-61
pubmed: 25443755
Phys Sportsmed. 2010 Apr;38(1):101-6
pubmed: 20424407
J Sports Med Phys Fitness. 1991 Sep;31(3):417-9
pubmed: 1798315
Br J Sports Med. 2003 Aug;37(4):300-3; discussion 303
pubmed: 12893712
J Int Soc Sports Nutr. 2014 Feb 10;11(1):3
pubmed: 24512517
Eur J Appl Physiol. 2012 Feb;112(2):689-97
pubmed: 21656229
Am J Emerg Med. 2014 Jul;32(7):813.e1-2
pubmed: 24461937
Kidney Int. 1989 Jan;35(1):69-75
pubmed: 2709662
Ann Intern Med. 1992 Dec 1;117(11):891-7
pubmed: 1443949
Int J Sports Med. 2011 Apr;32(4):297-302
pubmed: 21271498
Ann Nutr Metab. 2010;57 Suppl 2:9-17
pubmed: 21346332
Front Physiol. 2018 Jun 01;9:634
pubmed: 29910741
Eur J Appl Physiol. 2011 Jun;111(6):1007-16
pubmed: 21082192
Clin J Sport Med. 2015 Jul;25(4):347-54
pubmed: 25318530
Am J Med. 2007 May;120(5):461.e11-7
pubmed: 17466660
Am J Kidney Dis. 2002 Sep;40(3):508-16
pubmed: 12200802
Curr Sports Med Rep. 2018 Apr;17(4):123-125
pubmed: 29629971
Dtsch Med Wochenschr. 2007 Sep;132(36):1829-32
pubmed: 17726655
Alaska Med. 2002 Jul-Sep;44(3):51-5
pubmed: 12497664
Emerg Med Australas. 2017 Jun;29(3):370-371
pubmed: 28320047
Mil Med. 2018 Mar 1;183(3-4):e225-e228
pubmed: 29365179
J Sports Sci. 2007 May;25(7):781-96
pubmed: 17454546
Asia Pac J Clin Nutr. 2010;19(1):83-90
pubmed: 20199991
Am J Med Sci. 1996 Feb;311(2):86-91
pubmed: 8615381
Wilderness Environ Med. 2015 Jun;26(2):189-95
pubmed: 25736400
Am J Forensic Med Pathol. 2016 Mar;37(1):7-8
pubmed: 26600233
Wilderness Environ Med. 2008 Spring;19(1):42-4
pubmed: 18333641
J Appl Physiol (1985). 1988 Jul;65(1):318-24
pubmed: 3403475
Int J Sport Nutr Exerc Metab. 2015 Dec;25(6):603-6
pubmed: 26061675
Nutr J. 2013 Jan 15;12:13
pubmed: 23320854
Clin J Sport Med. 2007 Jul;17(4):307-10
pubmed: 17620786
Int J Sport Nutr. 1992 Sep;2(3):205-28
pubmed: 1299494
Clin J Sport Med. 2000 Jan;10(1):52-8
pubmed: 10695851
Med Sci Sports Exerc. 1990 Apr;22(2):165-70
pubmed: 2355812
Clin J Sport Med. 2008 Sep;18(5):379-81
pubmed: 18806542
Clin J Sport Med. 2017 Jul;27(4):e55-e57
pubmed: 28653967
J Sports Sci. 1991 Summer;9 Spec No:143-52
pubmed: 1895360
Clin J Sport Med. 2015 Jul;25(4):341-6
pubmed: 25010155
J Int Soc Sports Nutr. 2015 Jun 25;12:29
pubmed: 26113805
J Appl Physiol (1985). 1999 Jun;86(6):1847-51
pubmed: 10368348
Clin J Sport Med. 2012 Mar;22(2):146-51
pubmed: 22266743
S Afr Med J. 1969 Jul 19;43(29):893-6
pubmed: 5821601
Chin J Physiol. 2011 Dec 31;54(6):379-84
pubmed: 22229504
Am J Med. 2015 Oct;128(10):1144-51
pubmed: 25912199
Med Sci Sports Exerc. 2013 Apr;45(4):784-91
pubmed: 23135369
Clin J Sport Med. 1997 Apr;7(2):100-3
pubmed: 9113425
Br J Sports Med. 2002 Aug;36(4):301-3
pubmed: 12145122
J Emerg Med. 2001 Jul;21(1):47-57
pubmed: 11399389
N Engl J Med. 2005 Apr 14;352(15):1550-6
pubmed: 15829535
Clin J Sport Med. 2012 Nov;22(6):488-94
pubmed: 22584963
Med Sci Sports Exerc. 1989 Oct;21(5 Suppl):S222-5
pubmed: 2607954
J Strength Cond Res. 2017 Aug;31(8):2189-2207
pubmed: 28731980
Clin J Sport Med. 1997 Oct;7(4):292-301
pubmed: 9397327
BMJ Open Sport Exerc Med. 2018 Jun 20;4(1):e000351
pubmed: 29955376
Clin Ter. 2012;163(5):e349-56
pubmed: 23099986
Eur J Appl Physiol Occup Physiol. 1982;49(2):179-86
pubmed: 6889495
Mil Med Res. 2019 Jan 25;6(1):1
pubmed: 30678725
Eur J Appl Physiol Occup Physiol. 1997;76(6):517-24
pubmed: 9404863
PM R. 2016 Mar;8(3 Suppl):S61-8
pubmed: 26972268
J Sports Sci. 2012;30(10):1003-13
pubmed: 22554315
Sports Med. 2013 Dec;43(12):1289-99
pubmed: 23955577
S Afr Med J. 1979 Aug 18;56(7):261-5
pubmed: 550480
Clin J Sport Med. 2011 May;21(3):226-32
pubmed: 21427567
Res Sports Med. 2016 Jul-Sep;24(3):212-21
pubmed: 27258701
Clin J Sport Med. 2004 Nov;14(6):344-53
pubmed: 15523206
Clin J Sport Med. 2015 Jul;25(4):301-2
pubmed: 26102444
Clin J Am Soc Nephrol. 2007 Jan;2(1):151-61
pubmed: 17699400
Am J Physiol Regul Integr Comp Physiol. 2006 May;290(5):R1429-35
pubmed: 16373433
Wilderness Environ Med. 2010 Dec;21(4):303-8
pubmed: 21168782
Scand J Med Sci Sports. 2017 Feb;27(2):152-160
pubmed: 26661748
Clin J Sport Med. 2008 Mar;18(2):111-21
pubmed: 18332684
Emerg Med J. 2009 Dec;26(12):906-7
pubmed: 19934147
J Strength Cond Res. 2015 Jan;29(1):107-15
pubmed: 25029006
Am J Emerg Med. 1999 Oct;17(6):532-9
pubmed: 10530529
S Afr Med J. 1971 Feb 6;45(6):147-50
pubmed: 5553596
Clin J Sport Med. 2010 May;20(3):193-9
pubmed: 20445360
Med Sci Sports Exerc. 1999 Jun;31(6):809-15
pubmed: 10378907
Sports Med Open. 2016 Jul 19;2(1):26
pubmed: 27478761
Med Sci Sports Exerc. 2007 Feb;39(2):377-90
pubmed: 17277604
J Sports Med Phys Fitness. 2017 Nov;57(11):1499-1503
pubmed: 28085125
Horm Metab Res. 2012 Nov;44(12):919-26
pubmed: 22638835
J Urol. 1986 Dec;136(6):1176-80
pubmed: 3773085
Res Sports Med. 2011 Jan;19(1):14-27
pubmed: 21253973
Anasthesiol Intensivmed Notfallmed Schmerzther. 2012 Nov;47(11-12):696-702
pubmed: 23235900
Phys Sportsmed. 2008 Dec;36(1):55-61
pubmed: 20048472
Chin J Physiol. 2012 Jun 30;55(3):147-55
pubmed: 22784278
Clin J Sport Med. 2001 Jan;11(1):44-50
pubmed: 11176145
Sports Med. 2001;31(10):701-15
pubmed: 11547892
Eur J Appl Physiol Occup Physiol. 1985;54(4):391-7
pubmed: 4065126
Wilderness Environ Med. 2013 Dec;24(4):468-71
pubmed: 23948279
Scand J Med Sci Sports. 2017 Nov;27(11):1213-1220
pubmed: 27714955
BMJ Case Rep. 2012 Aug 27;2012:null
pubmed: 22927272
Wilderness Environ Med. 2015 Sep;26(3):371-4
pubmed: 25935312
J Clin Endocrinol Metab. 2008 Jun;93(6):2072-8
pubmed: 18349067
Curr Sports Med Rep. 2017 Jul/Aug;16(4):289-293
pubmed: 28696993
Clin J Sport Med. 2000 Oct;10(4):272-8
pubmed: 11086754
Clin J Sport Med. 2003 May;13(3):171-5
pubmed: 12792212
Wilderness Environ Med. 2017 Dec;28(4):291-298
pubmed: 28781178
Proc (Bayl Univ Med Cent). 2007 Oct;20(4):398-401
pubmed: 17948115
Am J Physiol Renal Physiol. 2004 Aug;287(2):F172-80
pubmed: 15271684
Clin J Sport Med. 2008 Mar;18(2):155-8
pubmed: 18332691
Br J Sports Med. 2004 Dec;38(6):718-24
pubmed: 15562165
J Sports Sci. 2012;30(11):1131-40
pubmed: 22668199
Int J Sports Physiol Perform. 2012 Mar;7(1):6-10
pubmed: 21941013
Med Sci Sports Exerc. 1990 Oct;22(5):581-7
pubmed: 2233195
Med Sci Sports Exerc. 1996 Jan;28(1):i-vii
pubmed: 9303999
Clin J Sport Med. 2005 Jul;15(4):208-13
pubmed: 16003032
Clin J Sport Med. 2003 Jan;13(1):41-7
pubmed: 12544163
Chin J Physiol. ;60(4):231-241
pubmed: 28847143
Med Sci Sports Exerc. 2006 Jan;38(1):193; author reply 194
pubmed: 16394977
J Clin Invest. 1958 Sep;37(9):1236-56
pubmed: 13575523