ReviewMedicina (Kaunas, Lithuania)2019
Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review.
Review in Medicina (Kaunas, Lithuania), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- TheFrontiers in physiology · 2026Pooled it
- Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review.Sports medicine - open · 2023Pooled it
- Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports.International journal of environmental research and public health · 2022Pooled it
- 24-Hour Ultra-Marathon Running: A Narrative Review of Performance Factors and Physiological Impacts.Sports medicine - open · 2026Review
- Validity and reliability of a wearable armband for continuous sweat conductivity monitoring during exercise.Frontiers in physiology · 2026Article
- Pathophysiology and treatment of exercise-associated hyponatremia.Journal of endocrinological investigation · 2026Review
- Impact of Menstrual Cycle and Oral Contraceptives on Haematological and Inflammatory Biomarkers in Highly Trained Female Athletes.Drug testing and analysis · 2025Article
- Hyponatraemia in ageing.Nature reviews. Endocrinology · 2025Review
- Acid-Base and Electrolyte Balance Responses in the Performance of Female Ultramarathon Runners in a 45 km Mountain Race.Nutrients · 2025Article
- Women in the triathlon-the differences between female and male triathletes: a narrative review.Frontiers in sports and active living · 2025Review
- Gastrointestinal symptoms among recreational long distance runners in China: prevalence, severity, and contributing factors.Frontiers in nutrition · 2025Article
- Exercise-Associated Hyponatremia: Serum Sodium, Symptomatology, Severity, and Sport Specificity.Open access journal of sports medicine · 2025Review
- Ultra-Cycling- Past, Present, Future: A Narrative Review.Sports medicine - open · 2024Review
- Hypothesized mechanisms of death in swimming: a systematic review.BMC sports science, medicine & rehabilitation · 2024Article
- Effect of a cajuína hydroelectrolytic drink on the physical performance and hydration status of recreational runners.Current research in physiology · 2024Article
- A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise.European journal of applied physiology · 2024Review
- Exercise-Induced Fluid Retention, Cardiac Volume Overload, and Peripheral Edema in Ultra-Distance Cyclists.Kidney international reports · 2024Article
- It's just how we do it: social processes in rapid weight loss for combat sports.Health psychology and behavioral medicine · 2024Article
- Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment.International journal of molecular sciences · 2023Article
- Hyponatremia in patients with arterial hypertension: pathophysiology and management.Archives of medical science : AMS · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.