The DOI matches its Crossref record; 22 of the 23 references it cites were found in a registry or an index.
Hyponatremia among runners in the Boston Marathon.
Open accessAbstract
BACKGROUND: Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia and to identify the principal risk factors. METHODS: Participants in the 2002 Boston Marathon were recruited one or two days before the race. Subjects completed a survey describing demographic information and training history. After the race, runners provided a blood sample and completed a questionnaire detailing their fluid consumption and urine output during the race. Prerace and postrace weights were recorded. Multivariate regression analyses were performed to identify risk factors associated with hyponatremia. RESULTS: Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses, hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. On multivariate analysis, hyponatremia was associated with weight gain (odds ratio, 4.2; 95 percent confidence interval, 2.2 to 8.2), a racing time of >4:00 hours (odds ratio for the comparison with a time of <3:30 hours, 7.4; 95 percent confidence interval, 2.9 to 23.1), and body-mass-index extremes. CONCLUSIONS: Hyponatremia occurs in a substantial fraction of nonelite marathon runners and can be severe. Considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia, whereas female sex, composition of fluids ingested, and use of nonsteroidal antiinflammatory drugs were not.
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“This can be a result of solute (primarily sodium) loss and/or excess fluid load [275].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [275]
In the citing paper
“Moreover, the impact of sex hormones on body fluid and sodium regulation has important implications for a number of syndromes for which women are at risk, including orthostatic hypotension, insulin resistance, polycystic ovary syndrome, and neurological consequences from postoperative (8) and exercise-associated hyponatremia (1).”
From Sex Hormone Effects on Body Fluid Regulation (2008) · cites this paper as [1]
In the citing paper
“A personalized drinking plan can be adjusted to all levels of runners, including recreational competitors who may drink in volumes exceeding their sweat rates and who should be warned about the dangers of developing hyponatremia (Almond et al., 2005).”
From Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers (2019) · cites this paper as Almond et al., 2005
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Hyponatremia, Cerebral Edema, and Noncardiogenic Pulmonary Edema in Marathon Runners
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Hyponatremia in ultradistance triathletes
Speedy, D. B., Noakes, T. D., Rogers, I. R., Thompson, J., Campbell, R. G., Kuttner, J. A., Boswell, D. R., Wright, S. P., & HAMLIN, M. (1999) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199906000-00008 · Cited by 283
Exercise-Associated Hyponatremia
Rosner, M. H., & Kirven, J. (2006) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.02730806 · Cited by 214
The Incidence, Risk Factors, and Clinical Manifestations of Hyponatremia in Marathon Runners
Hew, T. D., Chorley, J. N., Cianca, J. C., & Divine, J. G. (2003) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200301000-00008 · Cited by 203
Exercise-associated hyponatremia in marathon runners: a two-year experience
Davis, D. P., Videen, J. S., Marino, A., Vilke, G. M., Dunford, J. V., Camp, S. P. V., & Maharam, L. G. (2001) · Journal of Emergency Medicine · doi:10.1016/s0736-4679(01)00320-1 · Cited by 182
Fluid Replacement during Marathon Running
Noakes, T. D. (2003) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200309000-00007 · Cited by 174
A 12-yr profile of medical injury and illness for the Twin Cities Marathon
Roberts, W. O. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200009000-00004 · Cited by 166
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Cited by
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Exercise and Fluid Replacement
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31802ca597 · Cited by 1,497
Medicine & science in sports & exercise
Walle, J. M. L., Solá, I. B., Castillo, I., & Rodríguez, J. L. T. (1994) · Journal of the American Dietetic Association · doi:10.1016/0002-8223(94)92575-5 · Cited by 1,309
Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations
Verbalis, J. G., Goldsmith, S. R., Greenberg, A., Korzelius, C. A., Schrier, R. W., Sterns, R. H., & Thompson, C. J. (2013) · The American Journal of Medicine · doi:10.1016/j.amjmed.2013.07.006 · Cited by 1,254
Incidence and Prevalence of Hyponatremia
Upadhyay, A., Jaber, B. L., & Madias, N. E. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.05.005 · Cited by 809
Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations
Verbalis, J. G., Goldsmith, S. R., Greenberg, A., Schrier, R. W., & Sterns, R. H. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.09.001 · Cited by 607
Metadata
- Authors
- Almond, C. S. D., Shin, A. Y., Fortescue, E. B., Mannix, R. C., Wypij, D., Binstadt, B. A., Duncan, C. N., Olson, D. P., Salerno, A. E., Newburger, J. W., & Greenes, D. S.
- Affiliations
- Boston Children's Hospital (US)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-04-14
- Volume
- 352
- Issue
- 15
- Pages
- 1550-1556
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2020799520
- Cited by
- 553
- References
- 23
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 13 · 2023: 13 · 2022: 15 · 2021: 20 · 2020: 17 · 2019: 29 · 2018: 20 · 2017: 18 · 2016: 29 · 2015: 30 · 2014: 38 · 2013: 27 · 2012: 42
- FWCI
- 34.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01RR002172, RR02172)
- Topics
- Health Sciences › Medicine › Nephrology › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Physiology (medical) › Thermoregulation and physiological responses
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- hyponatremia, marathon runners, Boston Marathon, fluid intake, body mass index, race time, risk factors, nonsteroidal anti-inflammatory drugs, female sex
- MeSH terms
- Analysis of Variance, Beverages, Drinking, Female, Humans, Hyponatremia, Male, Risk Factors, Running, Sex Factors, Sodium, Time Factors, Urine, Water, Cohort Studies, Weight Gain, Body Mass Index, Logistic Models
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