Christopher S.D. Almond, M.D., M.P.H., Andrew Y. Shin, M.D., Elizabeth B. Fortescue, M.D., Rebekah C. Mannix, M.D., David Wypij, Ph.D., Bryce A. Binstadt, M.D., Ph.D., Christine N. Duncan, M.D., David P. Olson, M.D., Ph.D., Ann E. Salerno, M.D., Jane W. Newburger, M.D., M.P.H., and David S. Greenes, M.D.
Background Hyponatremia has emerged as an important cause ofrace-related death and life-threatening illness among marathonrunners. We studied a cohort of marathon runners to estimatethe incidence of hyponatremia and to identify the principalrisk factors.
Methods Participants in the 2002 Boston Marathon were recruitedone or two days before the race. Subjects completed a surveydescribing demographic information and training history. Afterthe race, runners provided a blood sample and completed a questionnairedetailing their fluid consumption and urine output during therace. Prerace and postrace weights were recorded. Multivariateregression analyses were performed to identify risk factorsassociated with hyponatremia.
Results Of 766 runners enrolled, 488 runners (64 percent) provideda usable blood sample at the finish line. Thirteen percent hadhyponatremia (a serum sodium concentration of 135 mmol per literor less); 0.6 percent had critical hyponatremia (120 mmol perliter or less). On univariate analyses, hyponatremia was associatedwith substantial weight gain, consumption of more than 3 litersof fluids during the race, consumption of fluids every mile,a racing time of >4:00 hours, female sex, and low body-massindex. On multivariate analysis, hyponatremia was associatedwith weight gain (odds ratio, 4.2; 95 percent confidence interval,2.2 to 8.2), a racing time of >4:00 hours (odds ratio forthe comparison with a time of <3:30 hours, 7.4; 95 percentconfidence interval, 2.9 to 23.1), and body-mass-index extremes.
Conclusions Hyponatremia occurs in a substantial fraction ofnonelite marathon runners and can be severe. Considerable weightgain while running, a long racing time, and body-mass-indexextremes were associated with hyponatremia, whereas female sex,composition of fluids ingested, and use of nonsteroidal antiinflammatorydrugs were not.
Source Information
From the Departments of Medicine (C.S.D.A., A.Y.S., E.B.F., R.C.M., B.A.B., C.N.D., D.P.O., A.E.S., D.S.G.) and Cardiology (D.W., J.W.N.) and the Clinical Research Program (D.W.), Children's Hospital; the Department of Pediatrics, Harvard Medical School (C.S.D.A., A.Y.S., E.B.F., R.C.M., D.W., B.A.B., C.N.D., D.P.O., A.E.S., J.W.N., D.S.G.); and the Department of Biostatistics, Harvard School of Public Health (D.W.) — all in Boston.
Address reprint requests to Dr. Almond at the Department of Cardiology, Children's Hospital, Bader 2, 300 Longwood Ave., Boston, MA 02115, or at christopher.almond{at}childrens.harvard.edu.
Hyponatremia in Marathon Runners
Peate W.F., Ayus J. C., Arieff A., Moritz M. L., Halperin M. L., Kamel K. S., Sterns R., Almond C. S.D., Shin A. Y., Greenes D. S.
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N Engl J Med 2005;
353:427-428, Jul 28, 2005.
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