Hyponatremia in the 2009 161-km Western States Endurance Run
Abstract
PURPOSE: To determine the incidence of exercise-associated hyponatremia (EAH), the associated biochemical measurements and risk factors for EAH, and whether there is an association between postrace blood sodium concentration ([Na+]) and changes in body mass among participants in the 2009 Western States Endurance Run, a 161-km mountain trail run. METHODS: Change in body mass, postrace [Na+], and blood creatine phosphokinase (CPK) concentration, and selected runner characteristics were evaluated among consenting competitors. RESULTS: Of the 47 study participants, 14 (30%) had EAH as defined by a postrace [Na+] <135 mmol/L. Postrace [Na+] and percent change in body mass were directly related (r = .30, P = .044), and 50% of those with EAH had body mass losses of 3-6%. EAH was unrelated to age, sex, finish time, or use of nonsteroidal anti-inflammatory drugs during the run, but those with EAH had completed a smaller (P = .03) number of 161-km ultramarathons. The relationship of CPK levels to postrace [Na+] did not reach statistical significance (r = -.25, P = .097). CONCLUSIONS: EAH was common (30%) among finishers of this 161-km ultramarathon and it was not unusual for those with EAH to be dehydrated. As such, changes in body mass should not be relied upon in the assessment for EAH during 161-km ultramarathons.
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EAH incidence rates of 15-30% were reported in ultra-endurance running races.
“15–30% in ultra- endurance running races [34,36]”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [34]
Cites
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 · see citing works
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 · see citing works
Self-citationHyponatremia 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 · see citing works
Self-citationHistorical Analysis of Participation in 161 km Ultramarathons in North America
Hoffman, M. D., Ong, J. C., & Wang, G. (2010) · The International Journal of the History of Sport · doi:10.1080/09523367.2010.494385 · Cited by 262 · see citing works
Self-citationWater Intoxication: A Possible Complication During Endurance Exercise☆
Noakes, T. D., Goodwin, N., Rayner, B. L., BRANKEN, T., & Taylor, R. K. N. (2005) · Wilderness and Environmental Medicine · doi:10.1580/1080-6032(2005)16[221:wiapcd]2.0.co;2 · Cited by 237 · see citing works
Hew‐Butler, T., Ayus, J. C., Kipps, C., Maughan, R. J., Mettler, S., Meeuwisse, W. H., Page, A., Reid, S. A., Rehrer, N. J., Roberts, W. O., et al. (2008) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e318168ff31 · Cited by 223 · see citing works
Self-citationFactors Related to Successful Completion of a 161-km Ultramarathon
Hoffman, M. D., & Fogard, K. (2011) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.6.1.25 · Cited by 208 · see citing works
Self-citationNoakes, T. D., GOODWIN, N., RAYNER, B. L., BRANKEN, T., & Taylor, R. K. N. (1985) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198506000-00012 · Cited by 197 · see citing works
Weight changes, medical complications, and performance during an Ironman triathlon
Sharwood, K. A., Collins, M., Goedecke, J. H., Wilson, G., & Noakes, T. D. (2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2003.007187 · Cited by 179 · see citing works
Fluid Balance During and After an Ironman Triathlon
Speedy, D. B., Noakes, T. D., Kimber, N. E., Rogers, I. R., Thompson, J., Boswell, D. R., Ross, J. J., Campbell, R. G., Gallagher, P. G., & Kuttner, J. A. (2001) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200101000-00008 · Cited by 171 · see citing works
Self-citationPerformance Trends in 161-km Ultramarathons
Hoffman, M. D. (2009) · International Journal of Sports Medicine · doi:10.1055/s-0029-1239561 · Cited by 133 · see citing works
Self-citationWeight Changes, Sodium Levels, and Performance in the South African Ironman Triathlon
Sharwood, K. A., Collins, M., Goedecke, J. H., Wilson, G., & Noakes, T. D. (2002) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200211000-00012 · Cited by 131 · see citing works
Demographic Characteristics of 161-km Ultramarathon Runners
Hoffman, M. D., & Fogard, K. (2012) · Research in Sports Medicine · doi:10.1080/15438627.2012.634707 · Cited by 105 · see citing works
Self-citationOral salt supplementation during ultradistance exercise
Speedy, D. B., Thompson, J. M. D., Rodgers, I., Collins, M., & Sharwood, K. (2002) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200209000-00004 · Cited by 104 · see citing works
Food Intake and Electrolyte Status of Ultramarathoners Competing in Extreme Heat
Glace, B. W., Murphy, C. A., & McHugh, M. P. (2002) · Journal of the American College of Nutrition · doi:10.1080/07315724.2002.10719254 · Cited by 97 · see citing works
The incidence of exercise-associated hyponatraemia in the London marathon
Kipps, C., Sharma, S., & Pedoe, D. T. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.059535 · Cited by 94 · see citing works
Hyponatremia and Weight Changes in an Ultradistance Triathlon
Speedy, D. B., Faris, J. G., Hamlin, M., Gallagher, P. G., & Campbell, R. G. (1997) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-199707000-00005 · Cited by 93 · see citing works
Hew‐Butler, T., Sharwood, K. A., Collins, M., Speedy, D. B., & Noakes, T. D. (2006) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.022418 · Cited by 93 · see citing works
Self-citationRisk Factors for Exercise-associated Hyponatremia in Non-elite Marathon Runners
Chorley, J. N., Cianca, J. C., & Divine, J. G. (2007) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e3181588790 · Cited by 92 · see citing works
Race Diet of Finishers and Non-Finishers in a 100 Mile (161 km) Mountain Footrace
Stuempfle, K. J., Hoffman, M. D., Weschler, L. B., Rogers, I. R., & Hew-Butler, T. (2011) · Journal of the American College of Nutrition · doi:10.1080/07315724.2011.10719999 · Cited by 86 · see citing works
Self-citationBruso, J. R., Hoffman, M. D., Rogers, I. R., Lee, L., Towle, G., & Hew-Butler, T. (2010) · Wilderness & Environmental Medicine · doi:10.1016/j.wem.2010.06.012 · Cited by 82 · see citing works
Self-citationLebus, D. K., Casazza, G. A., Hoffman, M. D., & Loan, M. D. V. (2010) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e3181da53ea · Cited by 79 · see citing works
Self-citationHew‐Butler, T., Collins, M., Bosch, A. N., Sharwood, K. A., Wilson, G., Armstrong, M. E. G., Jennings, C., Swart, J., & Noakes, T. D. (2007) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e3180326836 · Cited by 68 · see citing works
Self-citationEvaluation of i-STAT portable clinical analyzer in a neonatal and pediatric intensive care unit
Murthy, J. N., Hicks, J. M., & Soldin, S. J. (1997) · Clinical Biochemistry · doi:10.1016/s0009-9120(97)00046-5 · Cited by 67 · see citing works
Biochemical parameters in athletes before and after having run 160 kilometres.
Noakes, T. D., & Jw, C. (1976) · PubMed · Cited by 43 · see citing works
Exercise-Associated Hyponatremia with Rhabdomyolysis during Endurance Exercise
Ellis, C., Cuthill, J. A., Hew‐Butler, T., George, S. M., & Rosner, M. H. (2009) · The Physician and Sportsmedicine · doi:10.3810/psm.2009.04.1693 · Cited by 39 · see citing works
Self-citationHew‐Butler, T., Dugas, J. P., Noakes, T. D., & Verbalis, J. G. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.049742 · Cited by 35 · see citing works
Self-citationExertional Heat Illness and Hyponatremia
Carter, R. (2008) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e31817f38ff · Cited by 28 · see citing works
Serum Sodium Concentration Changes Are Related to Fluid Balance and Sweat Sodium Loss
Pahnke, M. D., Trinity, J. D., Zachwieja, J. J., Stofan, J. R., Hiller, W. D. B., & Coyle, E. F. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181d6c72a · Cited by 28 · see citing works
Hazards of ultra-marathon running in the Scottish highlands: exercise-associated hyponatraemia
Cuthill, J. A., Ellis, C., & Inglis, A. (2009) · Emergency Medicine Journal · doi:10.1136/emj.2008.065524 · Cited by 24 · see citing works
Tam, N., Hew‐Butler, T., Papadopoulou, E., Nolte, H. W., & Noakes, T. D. (2009) · Medicina Sportiva · doi:10.2478/v10036-009-0017-2 · Cited by 21 · see citing works
Self-citationSevere hyponatremia develops in a runner following a half-marathon
Glace, B. W., & Murphy, C. (2008) · JAAPA · doi:10.1097/01720610-200806000-00085 · Cited by 19 · see citing works
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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 · see citing works
Self-citationExercise-associated hyponatremia and hydration status in 161-km ultramarathoners
HOFFMAN, M. D., HEW-BUTLER, T., & STUEMPFLE, K. J. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31827985a8 · Cited by 111 · see citing works
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Stuempfle, K. J., Hoffman, M. D., Weschler, L. B., Rogers, I. R., & Hew-Butler, T. (2011) · Journal of the American College of Nutrition · doi:10.1080/07315724.2011.10719999 · Cited by 86 · see citing works
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Nikolaidis, P. T., Veniamakis, E., Rosemann, T., & Knechtle, B. (2018) · Nutrients · doi:10.3390/nu10121995 · Cited by 70 · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
BackgroundCairns, R. S., & Hew-Butler, T. (2015) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000144 · Cited by 37 · see citing works
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Self-citation
- Authors
- Hoffman, M. D., Stuempfle, K. J., Rogers, I. R., Weschler, L. B., & Hew-Butler, T.
- Affiliations
- VA Northern California Health Care System (US)
- Gettysburg College (US)
- Venue
- International Journal of Sports Physiology and Performance
- Publisher
- Human Kinetics
- Published
- 2012-03
- Volume
- 7
- Issue
- 1
- Pages
- 6-10
- ISSN
- 1555-0265 (ISSN-L)
- 1555-0273
- OpenAlex
- W2136337394
- Cited by
- 67
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 7 · 2018: 5 · 2017: 3 · 2016: 6 · 2015: 10 · 2014: 8 · 2013: 11 · 2012: 3
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Sports Physiology and Performance (publishedVersion)
- PubMed (publishedVersion)
- The Cupola: Scholarship at Gettysburg College (Gettysburg College) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Keywords
- exercise-associated hyponatremia, ultramarathon, weight change, creatine kinase, dehydration, risk factors, trail running
- MeSH terms
- Adult, California, Dehydration, Female, Hot Temperature, Humans, Hyponatremia, Male, Middle Aged, Physical Endurance, Risk Factors, Running, Body Mass Index, Incidence
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