Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015

  title={Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015},
  author={Tamara Hew-Butler and Mitchell H. Rosner and Sandra Fowkes-Godek and Jonathan P. Dugas and Martin D. Hoffman and Douglas P. Lewis and Ronald J. Maughan and Kevin C. Miller and Scott Montain and Nancy Jane Rehrer and William O. Roberts and Ian R. Rogers and Arthur J. Siegel and Kristin J. Stuempfle and James M Winger and Joseph G. Verbalis},
  journal={Clinical Journal of Sport Medicine},
The third International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California in February 2015 with a panel of 17 international experts. The delegates represented 4 countries and 9 medical and scientific sub-specialties pertaining to athletic training, exercise physiology, sports medicine, water/sodium metabolism, and body fluid homeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus… 

Preventing Deaths Due to Exercise-Associated Hyponatremia: The 2015 Consensus Guidelines.

  • M. Rosner
  • Medicine
    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
  • 2015
Despite strong evidence of the dangers of overly aggressive fluid intake beyond the body’s maximal fluid excretion rate, many athletes, coaches, trainers, and lay public continue to embrace the idea that “hyperhydration” has some health and performance benefits while the risks of EAH are overstated.

The Presented Evidence to Support Symptomatic Hypovolemic-Associated EAH Is Not Convincing.

This report retrospectively examined the trajectories of select biomarkers during recovery to conclude that ‘‘clear evidence for volume depletion as the primary pathophysiological mechanism for the development of severe, symptomatic EAH’’ in this case.

Case Study: Symptomatic Exercise-Associated Hyponatremia in an Endurance Runner Despite Sodium Supplementation.

  • M. HoffmanT. Myers
  • Medicine
    International journal of sport nutrition and exercise metabolism
  • 2015
This case demonstrates that while oral sodium supplementation does not necessarily prevent symptomatic EAH associated with overhydration, early recognition and field management with oral hypertonic saline in combination with fluid restriction can be effective treatment for mild EAH.

Exercise-Associated Hyponatremia: 2017 Update

This review focuses on the most recent literature in the field of EAH and summarizes key new findings in the epidemiology, pathophysiology, treatment, and prevention of this condition.

Special Communication of a Case of Hypovolemic-Associated EAH: Lessons Learned During Recovery.

Biochemical evidence is provided suggesting that this patient's severe symptomatic EAH was associated with volume depletion from underreplaced sodium losses, suggesting a 'reverse' perspective of the underlying pathophysiology.

Exercise‐Associated Collapse: Is Hyponatremia in Our Head?

Severe Exercise-Associated Hyponatremia in a Collegiate American Football Player.

A case of severe EAH is reported in a National Collegiate Athletic Association (NCAA) Division III collegiate football player and pearls and pitfalls in diagnosis and management are reviewed.

Response to Letter-to-the-Editor "The Presented Evidence to Support Symptomatic Hypovolemic-Associated EAH Is Not Convincing".

This study biochemically assessed volemic status in hyponatremic patients, originally classified as hypovolemic via clinical signs and symptoms, and demonstrated that normal saline administration to a patient with euvolemic hyp onatremia does not alter serum [Na].



Severe Exercise-Associated Hyponatremia on the Kokoda Trail, Papua New Guinea

A case of severe hyponatremia in a healthy male trekking the Kokoda Trail in the remote Southern Highlands of Papua New Guinea is reported, highlighting that a high index of suspicion is required to identify patients with exercise-associated hypon atremia.

Large-volume hypertonic saline therapy in endurance athlete with exercise-associated hyponatremic encephalopathy.

First reported cases of exercise-associated hyponatremia in Asia.

The need to disseminate advice for the prevention and treatment of EAH for races held in the tropics and fluid balance in long distance foot races in a warm and humid environment is indicated.

Update: Exertional hyponatremia, active component, U.S. Armed Forces, 1999-2013.

  • Medicine
  • 2014
In 2013, there were fewer incident cases of exertional hyponatremia among active component members of the U.S. Armed Forces than in any of the previous 9 years, reflecting sharply declining rates in the Marine Corps and slight decreases in the other Services.

Exercise-associated hyponatremia in marathon runners: a two-year experience.

Hyponatremia in the 2009 161-km Western States Endurance Run.

Changes in body mass should not be relied upon in the assessment for EAH during 161-km ultramarathons, and the relationship of CPK levels to postrace [Na+] did not reach statistical significance.

The incidence of exercise-associated hyponatraemia in the London marathon

Four of the 11 hyponatraemic runners lost weight over the course of the marathon, strengthening the case for an additional factor, such as inappropriate antidiuretic hormone release during exercise, in the development of EAH.

NSAID use increases the risk of developing hyponatremia during an Ironman triathlon.

Despite high rates of NSAID use, the incidence of hyponatremia was low and this is attributed to changes in fluid replacement guidelines and drink station availability that reduce the risk of overdrinking, the principal cause of this condition.

The Need for Salt: Does a Relationship Exist Between Cystic Fibrosis and Exercise-Associated Hyponatremia?

A null relationship between the 2010 and 2011 Western States Endurance Run ultramarathon and the CFTR mutations are not associated with the development of EAH and that salt supplementation is unnecessary for such a reason.

The Incidence, Risk Factors, and Clinical Manifestations of Hyponatremia in Marathon Runners

Vomiting was the only clinical sign differentiating hyponatremia from other conditions that induce exercise-associated collapse, and there were no significant differences in vital signs, training variables, or NSAID use between H and NH groups, although there was a trend towards the less experienced runners presenting with lower post-race sodium levels.