Hyperhydration and exercise-associated hyponatremia (EAH) are critical issues during endurance events. We studied a cohort of marathon runners to examine EAH's prevalence in a marathon with a short time limit and to investigate underlying mechanisms that may be responsible for its development.
Observational cohort study.
2006 Zurich Marathon (cool and rainy weather, time limit of 5 hours).
167 marathon runners were recruited the month before the race.
Body mass, plasma sodium, and osmolality were measured just before the start and immediately after the race. Fluid intake during the race was ascertained by a recall questionnaire.
Five subjects (3 %) developed asymptomatic EAH, and no symptomatic EAH was found. Body mass change during the race correlated similarly with postrace sodium levels (r = −0.72, P < 0.0001) and with sodium change during the race (r = −0.66, P < 0.0001). Postrace sodium levels correlated significantly with sodium change during the race (r = 0.74, P < 0.0001). Fluid intake correlated significantly (r = −0.43, P < 0.0001) with plasma sodium change between the start and finish of the race. Postrace sodium levels and postrace osmolality were significantly correlated (r = 0.68, P < 0.0001).
In this study we observed a relatively low incidence of EAH in subjects running the marathon in around 2.5 to 5 hours and in a cool environment. Plasma sodium change during the race and postrace sodium levels correlated with body mass change. There was also a direct correlation between fluid intake and plasma sodium change during the race.
From the *Department of Agricultural and Food Sciences, ETH Zurich; †Institute of Human Movement Sciences, ETH Zurich; ‡move>med Swiss Olympic Medical Center; and §Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
Submitted for publication February 5, 2008; accepted April 13, 2008.
There are no conflicts of interest for any of the authors.
Study data have not been previously published and are not currently submitted for publication.
Reprints: Samuel Mettler, MSc, Department of Agricultural and Food Sciences, ETH Zurich, ETH Zentrum-LFH A2, CH-8092 Zurich, Switzerland (e-mail: firstname.lastname@example.org).