Tuesday, November 09, 2004



It's hyponatremia - What is it and how does it effect us as endurance athletes? Well - basically it's over-hydration. I'm sharing this with everyone cause it can happen to you.... It happened to me and I didn't know what had happened until I read an article similar to this. So, I lived and learned, don't make the same mistake I did.

This year I was really nervous before Cornman Sprint Triathlon. For me this is that one race you really want to do well at. It is a Regional Qualifier for the USTA Age Group Championships and I knew if it all came together I would qualify. I was concerned about dehydrating during the race so I drank tons of water before the race. I had at least 100oz down before the start. The swim was fine, the bike was good and I had taken another 20oz of water. I was in 2nd place in my age class out of T2 when I knew something wasn't right. I felt like I had a water balloon in my stomach and I was developing a terrible headache. By the end of the 5k I had nothing left and I went from 2nd to 5th in my class. It was the worst I have ever felt after an event and it took several hours before I felt well again. I had a feeling I drank too much H2O because of the gut ache, but until reading an article on hyponatremia, I didn't know how serious it could have been.

Runners Beware: Over-Hydration Can Be More Dangerous Than Dehydration
Nearly one in five marathon runners exhibit symptoms of exercise-related hyponatremia(1)
Fort Washington, PA (October 30, 2003) – The more than 200,000 runners2 approaching the starting line of major marathoners this fall must be warned about a recently identified, potentially life-threatening hazard that may be caused by drinking too much water, hyponatremia.
"While the dangers of dehydration are common knowledge amongst amateur and experienced endurance athletes alike, there is something much more dangerous than not enough water: too much water," said Dr. Arthur Siegel, a physician at Harvard-affiliated McLean Hospital in Belmont, MA, and leading researcher on hyponatremia who has run 20 marathons. "We must educate runners to optimize rather than maximize fluid intake during extreme exercise to avoid water intoxication."
Exercise-related hyponatremia may occur during prolonged sports activity such as marathons, triathlons, long-distance hiking or bicycling when fluid intake, including water and sports drinks, exceeds fluid loss. When water dilutes the body's salts, the blood has too much water and too little sodium, causing brain cells to absorb too much water, swell and push against the skull.3 This can result in nausea, severe fatigue, disorientation, vomiting and, in the most severe cases, seizures, coma and even death.4
All endurance athletes who over-drink are at risk for hyponatremia, but those most prone to the condition include females and people with slower marathon finishing times (more than four hours) who are hyper-vigilant about their water intake5. A recent study conducted by Runner's World indicates that 74 percent of marathon runners take analgesics, and over 88 percent report use of nonsteroidal anti-inflammatory drugs (NSAIDs)6. However, runners who use NSAIDs like Advil® and Aleve® for pain relief in close proximity to race time may be at additional risk5.
Katherine "KC" Guevara experienced the horrors of hyponatremia first hand at the Boston Marathon this past April, only one year after the condition caused the collapse and subsequent death of 28 year old Cynthia Lucero after collapsing at the 22-mile mark.
"Even though I increased my salt intake the week before the race, I also drank almost three liters of water beforehand and drank more throughout. I knew at mile seven that something was wrong and I was in trouble," said Guevara, a 27-year old running enthusiast from Centerville, VA. "In the medical tent, I was woozy and slurring my speech and once someone took my sodium levels, they realized I had hyponatremia and gave me some hot, salty broth. The scary thing is, a few years ago, I may have been treated for dehydration – with more water."
Despite new hydration guidelines7,8 and educational materials developed by the USA Track & Field Association, the American Medical Athletic Association and marathon race directors, many runners have not gotten the word about hyponatremia.
Siegel said there are several simple steps runners can take to prevent hyponatremia.
"Runners should weigh themselves before and after their next long training run to determine if their body tends to retain fluid during endurance exercise," said Dr. Siegel. "If they gain weight, they are at risk for the condition and should take precautions during the marathon."
During a race, Dr. Siegel said it is vital that runners avoid over-drinking. Runners who develop progressive headache, nausea or vomiting should stop all fluid intake, including sports drinks, and seek medical assistance immediately. If a marathoner plans to take a pain reliever, take TYLENOL® 8 Hour, as a safe over-the-counter choice during endurance sports activity.
For more information about hyponatremia, please visit
www.marathonfirsttimers.com , a Web site designed to educate runners of all ages and abilities on the crucial aspects of running a marathon, including nutrition, apparel, injury prevention and pain treatment.
McNeil Consumer & Specialty Pharmaceuticals, a division of McNeil-PPC, Inc., is headquartered in Ft. Washington, PA, and markets products such as TYLENOL®, IMODIUM®, ST. JOSEPH® and MOTRIN®.
Tips on Preventing Hyponatremia – The Do's and Don'ts of Water Intake: How Much is Too Much?
For years, the mantra among runners has been: "Drink as much water as possible." But a condition called exercise-related hyponatremia shows that, like many things, too much of a good thing can be unhealthy.
Hyponatremia occurs when fluid intake – including sports drinks – exceeds fluid loss during exercise, throwing off the balance between the body's water and sodium levels. When the blood has too much water and too little sodium, brain cells absorb too much water and the brain swells, pushing against the skull. This condition can lead to nausea, fatigue and vomiting and, in the most severe instances, seizures, coma and even death.
All endurance athletes who over-drink are at risk for hyponatremia, but those most prone to the condition include females and people with marathon times over four hours who are hyper-vigilant about their water intake. Additionally, runners who use nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil® and Aleve® for pain relief in close proximity to race time may be at additional risk.
Some Do's and Don'ts on Avoiding Hyponatremia:
DO drink moderately during races as recommended in new guidelines developed by the American Medical Athletic Association and USA Track & Field.
DON'T drink more than 16-24 ounces of fluid, including sports drinks, one to two hours before running a race.
DO figure out personal intake and output levels by weighing yourself before and after a training run:
If you lost weight, you should drink more the next time.
If you gained weight, you should drink less.
DON'T take NSAIDs like Advil® and Aleve® before or during endurance events because, according to a few published reports, these over-the-counter pain relievers seem to increase the risk for hyponatremia. Do take acetaminophen, or TYLENOL® 8 Hour, as a safe over-the-counter choice for your muscle aches and pains.
DO stop all fluid intake if you experience weight gain with progressive symptoms such as swollen hands and feet, confusion, throbbing headache, dizziness and nausea.

Hey! Great topic Eduardo! I think I may have suffered from this in the past! I knew salt intake was vital, but there is a little more going on here, isn't there?

Had to laugh at the title! It reminds me of things I say to my wife when she is telling me about her R.N. experiences at the clinic. Maybe Jeff should link this post to his site? Enduro bikers need to know!
that Kathy lady drank 3 liters of water beforehand!!??
sounds like she lost a bet! i don't think i could down that much agua in one morning. how much time do you think she spent in line for the porta-johns? how many pit stops do you think she had to make during the race?
do you think she'll lose her evian sponsorship now that the world knows the true story?
stick w/ Juels and myself Eduardo you'll never go into a coma because you ate too much ice cream before a 10K.
dirty dirtram
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Keep On Running!
The Lonely Runner
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