Higher prevalence of exercise-associated hyponatremia in triple iron ultra-triathletes than reported for ironman triathletes
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"In a recent study of male and female ultra-marathoners in a 161-km ultra-marathon, the prevalence of exercise-associated hyponatremia (EAH) was higher than reported for marathoners. Regarding triathletes, the prevalence of EAH has been investigated in Ironman triathletes, but not in Triple Iron ultra-triathletes. The aim of this study was to investigate the prevalence of EAH in male ultra-triathletes competing in a Triple Iron ultra-triathlon over 11.4 km swimming, 540 km cycling, and 126.6 km running. Changes in body mass, fat mass, skeletal muscle mass, total body water, haematocrit, plasma volume, plasma sodium concentration ([Na ⁺ ]) and urine specific gravity were determined in 31 male athletes with (means ± standard deviation) 42.1 ± 8.1 years of age, 77.0 ± 7.0 kg body mass, 1.78 ± 0.06 m body height and a BMI of 24.3 ± 1.7 kg/m² in the 'Triple Iron Triathlon Germany'. Of the 31 finishers, eight athletes (26%) developed asymptomatic EAH. Body mass, fat mass, skeletal muscle mass, and haematocrit decreased, plasma volume increased ( P < 0.05), plasma [Na ⁺], total body water and urine specific gravity remained stable. The decrease in body mass was related to both the decrease in fat mass and skeletal muscle mass ( P < 0.05), but was not related to overall race time, the change in plasma [Na ⁺ ], post-race plasma [Na ⁺ ], or urine specific gravity. The prevalence of EAH was higher in these Triple Iron ultra-triathletes compared to existing reports on Ironman triathletes. Body fluid homeostasis remained stable in these ultra-triathletes although body mass decreased."
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EAH is a disorder of fluids and electrolytes that has been widely described in marathon runners and competitors in other endurance and ultra-endurance events such as cycling races of 24 h or ≥150 km, foot races of 24 h or ≥100 km, Ironman triathlons, or open-water swimming events.
“EAH is a disorder of fluids and electrolytes that has been widely described in marathon runners [32] and competitors in other endurance and ultra-endurance events such as: cycling races of 24 h or ≥150 km [28,40,43], foot races of 24 h or ≥100 km [28,31], Ironman triathlons [13,32], or open-water swimming events [43].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [32]
Ultra-endurance athletes competing in events that exceed 24 h are at a higher risk of developing EAH compared to participants in shorter endurance tests, such as the marathon.
“Studies suggest that ultra-endurance athletes competing in events that exceed 24 h, such as Ultraman, Titan Desert, or Sables Marathon participants, are at a higher risk of developing EAH compared to participants in shorter endurance tests, as could be the case of the marathon [32].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [32]
EAH incidence rates of 6-18% were reported for Ironman.
“incidence rates of 6–18% were reported for Ironman [13,32]”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [32]
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Self-citationSudden death in triathlon: Prevalence and mechanisms
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Balraj, M., Asokan, V., Ravi, K., Mani, V., Muninathan, N., Dhanavel, A., & Darshini, D. (2025) · International journal of Nutrition Pharmacology Neurological Diseases · doi:10.4103/ijnpnd.ijnpnd_99_25
- Authors
- Rüst, C. A., Knechtle, B., Knechtle, P., & Rosemann, T. J.
- Affiliations
- University of Zurich (CH)
- Venue
- Chinese Journal of Physiology
- Publisher
- Medknow
- Published
- 2012-06-30
- Volume
- 55
- Issue
- 3
- Pages
- 147-155
- ISSN
- 0304-4920 (ISSN-L)
- OpenAlex
- W2119456365
- Cited by
- 31
- References
- 57
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 2 · 2020: 2 · 2019: 1 · 2018: 5 · 2015: 3 · 2014: 5 · 2013: 7 · 2012: 2
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Chinese Journal of Physiology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- 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, plasma sodium, fluid homeostasis, weight loss, fat mass, skeletal muscle mass, plasma volume, hematocrit, urine specific gravity, total body water
- MeSH terms
- Humans, Hyponatremia, Iron, Physical Endurance, Running, Prevalence
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