Ross S Cairns1, Tamara Hew-Butler. 1. *Newcastle Sports Medicine, Charlestown, Australia; and †School of Health Sciences, Oakland University, Rochester, Michigan.
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.
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.
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