The DOI matches its Crossref record; 40 of the 41 references it cites were found in a registry or an index.
Incidence of Exercise-Associated Hyponatremia and Its Association With Nonosmotic Stimuli of Arginine Vasopressin in the GNW100s Ultra-endurance Marathon
Abstract
OBJECTIVES: (1) To examine the incidence of exercise-associated hyponatremia (EAH) during and after an ultramarathon and (2) to evaluate hypothesized nonosmotic stimuli [interleukin-6 (IL-6), hypoglycemia, ambient temperature] with arginine vasopressin (AVP) concentrations in hyponatremic versus normonatremic runners. DESIGN: Prospective cohort study. SETTING: The Great North Walk 100s ultramarathons. PARTICIPANTS: Fifteen runners participated in either 103.7- or 173.7-km ultramarathons. MAIN OUTCOME MEASURES: Serum sodium concentration ([Na]) and AVP concentration. Secondary outcome measures included IL-6, blood glucose, ambient temperature, weight change, fluid consumption, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS: Postrace EAH incidence was 4 of 15 runners, whereas EAH incidence at any point during the race was in 10 of 15 runners. A significant positive correlation was noted between AVP and IL-6 (r = 0.31, P < 0.05) but not between AVP and blood glucose (r = 0.09, nonsignificant) or ambient temperature (r = -0.12, NS). Subgroup analysis revealed that the correlation between AVP and IL-6 was significant in hyponatremic (r = 0.37, P < 0.05) but not normonatremic runners (r = 0.31, NS). Hyponatremic runners lost less weight than normonatremic runners (2.5 vs. 3.7 kg, P < 0.05, respectively) despite similar fluid consumption. Seven of 10 hyponatremic runners consumed NSAIDs versus 0 of 5 normonatremic runners. CONCLUSIONS: Exercise-associated hyponatremia incidence mid-race is higher than postrace, suggesting that 40% of runners are able to self-correct low serum [Na] status during an ultramarathon. Interleukin-6 seems to be the main nonosmotic stimulus associated with AVP in hyponatremic runners. Nonsteroidal anti-inflammatory ingestion is more common in hyponatremic versus normonatremic runners. CLINICAL RELEVANCE: Exercise-associated hyponatremia associated with nonosmotic AVP secretion may be more common during ultramarathon races without discriminatory clinical symptomatology.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“which in some endurance and ultra-endurance competitions has affected as many as 30% of the participants [12].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [12]
In the citing paper
“However, the signs and symptoms of EAH are nonspecific and can be superimposed on or confused with those of other diseases such as EHS, GI symptoms, and hypoglycemia, which are also frequent in these types of event.”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [12]
In the citing paper
“The risk factors that have been identified regarding the development of EAH include: female sex, alcohol consumption, excess of fluid replacement, weight gain during exercise, low body weight, slow running performance and inexperience in endurance events [12].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [12]
Citations
Cites
Steensberg, A., van Hall, G., Osada, T., Sacchetti, M., Saltin, B., & Pedersen, B. K. (2000) · The Journal of Physiology · doi:10.1111/j.1469-7793.2000.00237.x · Cited by 1,095
Interleukin-6 stimulates lipolysis and fat oxidation in humans
van Hall, G., Steensberg, A., Sacchetti, M., Fischer, C., Keller, C., Schjerling, P., Hiscock, N., Møller, K., Saltin, B., Febbraio, M. A., et al. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021687 · Cited by 767
Evidence that interleukin-6 is produced in human skeletal muscle during prolonged running
Ostrowski, K., Rohde, T., Zacho, M., Asp, S., & Pedersen, B. K. (1998) · The Journal of Physiology · doi:10.1111/j.1469-7793.1998.949bp.x · Cited by 673
Hyponatremia among runners in the Boston Marathon.
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., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043901 · Cited by 553
Disorders of body water homeostasis
Verbalis, J. G. (2003) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/s1521-690x(03)00049-6 · Cited by 457
Contraction-Induced Myokine Production and Release: Is Skeletal Muscle an Endocrine Organ?
Febbraio, M. A., & Pedersen, B. K. (2005) · Exercise and Sport Sciences Reviews · doi:10.1097/00003677-200507000-00003 · Cited by 402
Physical activity and plasma interleukin-6 in humans - effect of intensity of exercise
Ostrowski, K., Schjerling, P., & Pedersen, B. K. (2000) · European Journal of Applied Physiology · doi:10.1007/s004210000312 · Cited by 355
Noakes, T. D., Sharwood, K. A., Speedy, D. B., Hew, T. D., Reid, S., Dugas, J. P., Almond, C. S. D., WHARAM, P. C., & Weschler, L. B. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0509096102 · Cited by 330
Mastorakos, G., Weber, J. S., Magiakou, M. A., Gunn, H., & Chrousos, G. P. (1994) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.79.4.7962300 · Cited by 290
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
Cited by
Sorted by citations
Périard, J. D., Eijsvogels, T. M. H., & Daanen, H. A. M. (2021) · Physiological Reviews · doi:10.1152/physrev.00038.2020 · Cited by 774
Physiology and Pathophysiology in Ultra-Marathon Running
Knechtle, B., & Nikolaidis, P. Τ. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.00634 · Cited by 352
Reeder, J. T., Choi, J., Xue, Y., Gutruf, P., Hanson, J., Liu, M., Ray, T., Bandodkar, A. J., Avila, R., Xia, W., et al. (2019) · Science Advances · doi:10.1126/sciadv.aau6356 · Cited by 308
Hew-Butler, T., Rosner, M. H., Fowkes-Godek, S., Dugas, J. P., Hoffman, M. D., Lewis, D. P., Maughan, R. J., Miller, K. C., Montain, S. J., Rehrer, N. J., et al. (2015) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000221 · Cited by 205
Self-citationHew‐Butler, T., Rosner, M. H., Godek, S. F., Dugas, J. P., Hoffman, M. D., Lewis, D. P., Maughan, R. J., Miller, K. C., Montain, S. J., Rehrer, N. J., et al. (2015) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-095004 · Cited by 129
Self-citationAcute kidney injury associated with non-steroidal anti-inflammatory drugs
Klomjit, N., & Ungprasert, P. (2022) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2022.05.003 · Cited by 127
Exercise-Associated Hyponatremia: 2017 Update
Hew-Butler, T., Loi, V., Pani, A., & Rosner, M. H. (2017) · Frontiers in Medicine · doi:10.3389/fmed.2017.00021 · Cited by 112
Self-citationKnechtle, B., Chlíbková, D., Papadopoulou, S. Κ., Mantzorou, M., Rosemann, T. J., & Nikolaidis, P. Τ. (2019) · Medicina · doi:10.3390/medicina55090537 · Cited by 64
Ten common pitfalls in the evaluation of patients with hyponatremia
Filippatos, T. D., Liamis, G. L., Christopoulou, F., & Elisaf, M. (2015) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2015.11.022 · Cited by 51
Acute and Chronic Effects of Endurance Running on Inflammatory Markers: A Systematic Review
Barros, E., Nascimento, D. D. C., Prestes, J., Nóbrega, O. D. T., Córdova, C., Sousa, F., & Boullosa, D. A. (2017) · Frontiers in Physiology · doi:10.3389/fphys.2017.00779 · Cited by 56
Bennett, B. L., Hew‐Butler, T., Rosner, M. H., Myers, T. M., & Lipman, G. S. (2020) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2019.11.003 · Cited by 45
Self-citationExercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons
Krabak, B. J., Lipman, G. S., Waite, B. L., & Rundell, S. D. (2017) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2017.05.008 · Cited by 38
Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports
Veniamakis, E., Kaplanis, G., Voulgaris, P., & Nikolaidis, P. Τ. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063651 · Cited by 43
Heat Stress Challenges in Marathon vs. Ultra-Endurance Running
Bouscaren, N., Millet, G. Y., & Racinais, S. (2019) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2019.00059 · Cited by 33
Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review
Tidmas, V., Brazier, J., Bottoms, L. M., Muniz‐Pumares, D., Desai, T., Hawkins, J., Sridharan, S., & Farrington, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416887 · Cited by 37
Cairns, R. S., & Hew‐Butler, T. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-015-3324-4 · Cited by 26
Self-citationMartínez-Sanz, J. M., Fernández Nuñez, A., Sospedra, I., Martínez-Rodríguez, A., Domínguez, R., González-Jurado, J. A., & Sánchez-Oliver, A. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114082 · Cited by 25
Incidence of Hyponatremia During a Continuous 246-km Ultramarathon Running Race
Seal, A., Anastasiou, C. A., Skenderi, K., Echegaray, M., Yiannakouris, N., Tsekouras, Y. E., Matalas, A., Yannakoulia, M., Pechlivani, F., & Kavouras, S. A. (2019) · Frontiers in Nutrition · doi:10.3389/fnut.2019.00161 · Cited by 23
Dixon, B. N., Daley, R. J., Buie, L. W., Hsu, M., Park, J. H., Brentjens, R. J., Purdon, T. J., & Latcha, S. (2019) · Clinical Nephrology · doi:10.5414/cn109872 · Cited by 21
Nolte, H. W., Nolte, K., & Hew‐Butler, T. (2019) · Military Medical Research · doi:10.1186/s40779-019-0192-y · Cited by 13
Self-citationSerum sodium changes in marathon participants who use NSAIDs
Whatmough, S., Mears, S. A., & Kipps, C. (2018) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2018-000364 · Cited by 12
Exercise‐Associated Collapse: Is Hyponatremia in Our Head?
Krabak, B. J., Parker, K. M., & DiGirolamo, A. (2016) · PM&R · doi:10.1016/j.pmrj.2015.10.002 · Cited by 13
Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease
Miura, K., Harita, Y., Takahashi, N., Tsurumi, H., Yasudo, H., Isojima, T., Hirata, Y., Inuzuka, R., Takizawa, K., Toyofuku, E., et al. (2019) · Pediatrics International · doi:10.1111/ped.14036 · Cited by 11
Special Considerations in Medical Screening for Participants in Remote Endurance Events
Joslin, J., Hoffman, M. D., Rogers, I., Worthing, R. M., Ladbrook, M., & Mularella, J. (2015) · Sports Medicine · doi:10.1007/s40279-015-0342-7 · Cited by 10
Association of red blood cell size and physical fitness in a military male cohort: The CHIEF study
Lai, S., Tsai, K., Lin, Y., Liu, P., Lin, Y., Chang, P., Dai, M., Chao, T., Han, C., & Lin, G. (2020) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13836 · Cited by 9
Dysnatremia among runners in a half marathon performed under warm and humid conditions
Martínez-Cano, J. P., Cortes-Castillo, V., Martinez-Villa, J., Ramos, J. C., & Uribe, J. P. (2018) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2018-000351 · Cited by 8
A review of risk factors and prevention strategies for exercise associated hyponatremia
Seal, A., & Kavouras, S. A. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102930 · Cited by 8
Chlíbková, D. (2017) · The Chinese Journal of Physiology · doi:10.4077/cjp.2017.baf443 · Cited by 6
Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon
Khodaee, M., Saeedi, A., Harris-Spinks, C., & Hew‐Butler, T. (2021) · Physical Activity and Nutrition · doi:10.20463/pan.2021.0016 · Cited by 5
Self-citationDie belastungsassoziierte Hyponatriämie im Ausdauersport
Knechtle, B., Chlíbková, D., & Nikolaidis, P. Τ. (2019) · Praxis · doi:10.1024/1661-8157/a003261 · Cited by 5
Hoffman, M. D., Joslin, J., & Rogers, I. R. (2015) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000200 · Cited by 4
Jang, L.-C., & Park, S. S. (2016) · Vascular Specialist International · doi:10.5758/vsi.2016.32.3.129 · Cited by 2
Emerson, D. M., Kelly, M. R., Torres-McGehee, T. M., Uriegas, N. A., Smith, M. O., Smith, A. B., & Kloesel, K. A. (2024) · Nutrients · doi:10.3390/nu17010079 · Cited by 1
Pathophysiology and treatment of exercise-associated hyponatremia
Altieri, B., Aini, I., Cannavale, G., Magnelli, C., Mancini, C., Zamponi, V., Isidori, A. M., Colao, A. A. L., Faggiano, A., Peri, A., et al. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02673-7 · Cited by 1
Knechtle, B., Weiss, K., Valero, D., Villiger, E., Nikolaidis, P. Τ., Andrade, M. S., Scheer, V., Čuk, I., Gajda, R., & Thuany, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303960 · Cited by 5
Caring for and Counseling the Ultramarathoner
Ingwerson, J. L., & Krabak, B. J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-67949-7.00023-9
Hurdling the Challenges of the 2019 IAAF World Championships
(409080), O. G., Racinais, S., Édouard, P., (8540739), A. R., Navarro, L., Grémeaux, V., (8540754), P. B., (17471385), A. J., (7512125), F. J. H., (9728127), A. M. E., et al. (2020) · Frontiers research topics · doi:10.3389/978-2-88963-499-6
Metadata
- Authors
- Cairns, R. S., & Hew-Butler, T.
- Affiliations
- Oakland University (US)
- Corresponding author
- Cairns, Ross S.
- Venue
- Clinical Journal of Sport Medicine
- Published
- 2015-07
- Volume
- 25
- Issue
- 4
- Pages
- 347-354
- ISSN
- 1050-642X (ISSN-L)
- OpenAlex
- W2320619157
- Cited by
- 37
- References
- 41
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 9 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 5
- FWCI
- 3.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Sport Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Physiology (medical) › Thermoregulation and physiological responses
- Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
- Keywords
- exercise-associated hyponatremia, vasopressin, interleukin-6, ultramarathon, marathon runners, serum sodium, hypoglycemia, ambient temperature, weight loss, NSAID use, fluid intake
- MeSH terms
- Adult, Anti-Inflammatory Agents, Non-Steroidal, Arginine Vasopressin, Blood Glucose, Body Weight, Drinking Behavior, Humans, Hypoglycemia, Hyponatremia, Middle Aged, Prospective Studies, Risk Factors, Running, Sodium, Temperature, Cohort Studies, Interleukin-6, Incidence, Linear Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
