Download PDF
Horm Metab Res 2011; 43(09): 646-652
DOI: 10.1055/s-0031-1284352
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Maintained Serum Sodium in Male Ultra-Marathoners – The Role of Fluid Intake, Vasopressin, and Aldosterone in Fluid and Electrolyte Regulation

J. Bürge
1   Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
,
B. Knechtle
1   Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
2   Gesundheitszentrum St. Gallen, St. Gallen, Switzerland
,
P. Knechtle
2   Gesundheitszentrum St. Gallen, St. Gallen, Switzerland
,
M. Gnädinger
1   Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
,
C. A. Rüst
1   Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
,
T. Rosemann
1   Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

received 22 February 2011

accepted 30 June 2011

Publication Date:
05 August 2011 (online)

Also available at
    Permissions and Reprints

Corrected by:

Maintained Serum Sodium in Male Ultra-Marathoners – The Role of Fluid Intake, Vasopressin, and Aldosterone in Fluid and Electrolyte RegulationHorm Metab Res 2011; 43(09): e1-e1
DOI: 10.1055/s-0032-1322555

Corrected by:

Maintained Serum Sodium in Male Ultra-Marathoners – The Role of Fluid Intake, Vasopressin, and Aldosterone in Fluid and Electrolyte RegulationHorm Metab Res 2012; 44(09): 711-711
DOI: 10.1055/s-0032-1325139

Abstract

Exercise-associated hyponatremia (EAH) is a well know electrolyte disorder in endurance athletes. Although fluid overload is the most like etiology, recent studies, however, argued whether EAH is a disorder of vasopressin secretion. The aims of the present study were to investigate (i) the prevalence of EAH in male ultra-marathoners and (ii) whether fluid intake, aldosterone or vasopressin, as measured by copeptin, were associated with post-race serum sodium concentration ([Na+]). In 50 male ultra-marathoners in a 100 km ultra-marathon, serum [Na+], aldosterone, copeptin, serum and urine osmolality, and body mass were measured pre- and post-race. Fluid intake, renal function parameters and urine excretion were measured. No athlete developed EAH. Copeptin and aldosterone increased; a significant correlation was found between the change in copeptin and the change in serum [Na+], no correlation was found between aldosterone and serum [Na+]. Serum [Na+] increased by 1.6%; body mass decreased by 1.9 kg. The change in serum [Na+] and body mass correlated significantly and negatively. The fluid intake of ~ 0.58 l/h was positively related to the change in body mass and negatively to both post-race serum [Na+] and the change in serum [Na+]. We conclude that serum [Na+] was maintained by both the mechanisms of fluid intake and the hormonal regulation of vasopressin.

Key words

electrolytes - aldosterone - vasopressin - ultra-endurance
 

  • References

  • 1 Noakes TD, Norman RJ, Buck RH, Godlonton J, Stevenson K, Pittaway D. The incidence of hyponatremia during prolonged ultraendurance exercise. Med Sci Sports Exerc 1990; 22: 165-170
    PubMedGoogle Scholar
  • 2 Siegel AJ, Verbalis JG, Clement S, Mendelson JH, Mello NK, Adner M, Shirey T, Glowacki J, Lee-Lewandrowski E, Lewandrowski KB. Hyponatremia in marathon runners due to inappropriate arginine vasopressin secretion. Am J Med 2007; 120: 11-17
    PubMedGoogle Scholar
  • 3 Speedy DB, Noakes TD, Rogers IR, Thompson JM, Campbell RG, Kuttner JA, Boswell DR, Wright S, Hamlin M. Hyponatremia in ultradistance triathletes. Med Sci Sports Exerc 1999; 31: 809-815
    PubMedGoogle Scholar
  • 4 Verbalis JG. Renal function and vasopressin during marathon running. Sports Med 2007; 37: 455-458
    CrossrefPubMedGoogle Scholar
  • 5 Kipps C, Sharma S, Tunstall Pedoe D. The incidence of exercise-associated hyponatremia in the London Marathon. Br J Sports Med 2011; 45: 14-19
    CrossrefPubMedGoogle Scholar
  • 6 Noakes TD, Goodwin N, Rayner BL, Branken T. Water intoxication: a possible complication during endurance exercise. Med Sci Sports Exerc 1985; 17: 370-375
    PubMedGoogle Scholar
  • 7 Rosner MH. Exercise-associated hyponatremia. Semin Nephrol 2009; 29: 271-281
    CrossrefPubMedGoogle Scholar
  • 8 Knechtle B, Knechtle P, Rosemann T. Low prevalence of exercise-associated hyponatremia in male 100 km ultra-marathon runners in Switzerland. Eur J Appl Physiol 2011; 111: 1007-1016
    CrossrefPubMedGoogle Scholar
  • 9 Hew TD, Chorley JN, Cianca JC, Divine JG. The incidence, risk factors, and clinical manifestations of hyponatremia in marathon runners. Clin J Sport Med 2003; 13: 41-47
    CrossrefPubMedGoogle Scholar
  • 10 Hew-Butler T, Ayus JC, Kipps C, Maughan RJ, Mettler S, Meeuwisse WH, Page AJ, Reid SA, Rehrer NJ, Roberts WO, Rogers IR, Rosner MH, Siegel AJ, Speedy DB, Stuempfle KJ, Verbalis JG, Weschler LB, Wharam P. Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference, New Zealand, 2007. Clin J Sport Med 2008; 18: 111-1121
    CrossrefPubMedGoogle Scholar
  • 11 Lebus DK, Casazza GA, Hoffman MD, Van Loan MD. Can changes in body mass and total body water accurately predict kyponatremia after a 161-km running race?. Clin J Sport Med 2010; 20: 193-199
    CrossrefPubMedGoogle Scholar
  • 12 Irving RA, Noakes TD, Buck R, van Zyl Smit R, Raine E, Godlonton J, Norman RJ. Evaluation of renal function and fluid homeostasis during recovery from exercise-induced hyponatremia. J Appl Physiol 1991; 70: 342-348
    PubMedGoogle Scholar
  • 13 Stuempfle DJ, Lehmann DR, Case HS, Hughes SL, Evans D. Change in sodium concentration during a cold weather ultradistance race. Clin J Sport Med 2003; 13: 171-175
    CrossrefPubMedGoogle Scholar
  • 14 Hew-Butler T, Jordaan E, Stuempfle KJ, Speedy DB, Siegel AJ, Noakes TD, Soldin SJ, Verbalis JG. Osmotic and nonosmotic regulation of arginin vasopressin during prolonged endurance exercise. J Clin Endocrinol Metab 2008; 93: 2072-2078
    CrossrefPubMedGoogle Scholar
  • 15 Mettler S, Rusch C, Frey WO, Bestmann L, Wenk C, Colombani PC. Hyponatremia among runners in the Zurich Marathon. Clin J Sport Med 2008; 18: 344-349
    CrossrefPubMedGoogle Scholar
  • 16 Noakes TD, Sharwood K, Speedy D, Hew T, Reid S, Dugas J, Almond C, Wharam P, Weschler L. Three independent biological mechanisms cause exercise-associated hyponatremia: evidence from 2 135 weighed competitive athletic performances. Proc Natl Acad Sci USA 2005; 102: 18550-18555
    CrossrefPubMedGoogle Scholar
  • 17 Twerenbold R, Knechtle B, Kakebeeke TH, Eser P, Müller G, von Arx P, Knecht H. Effects of different sodium concentrations in replacement fluids during prolonged exercise in women. Br J Sports Med 2003; 37: 300-303
    CrossrefPubMedGoogle Scholar
  • 18 Morgenthaler NG, Struck J, Alonso C, Bergmann A. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem 2006; 52: 112-119
    CrossrefPubMedGoogle Scholar
  • 19 Milledge JS, Bryson EI, Catley DM, Hesp R, Luff N, Minty BD, Older MW, Payne NN, Ward MP, Withey WR. Sodium balance, fluid homeostasis and the renin-aldosteronsystem during the prolonged exercise of hill walking. Clin Sci (Lond) 1982; 62: 595-604
    PubMedGoogle Scholar
  • 20 Hew-Butler T. Arginine vasopressin, fluid balance and exercise. Is exercise-associated hyponatremia a disorder of arginine vasopressin secretion?. Sports Med 2010; 40: 459-479
    CrossrefPubMedGoogle Scholar
  • 21 Espinel CH. The FENa-Test. Use in differential diagnosis of acute renal failure. JAMA 1976; 236: 579-581
    CrossrefPubMedGoogle Scholar
  • 22 West ML, Marsden PA, Richardson RM, Zettle RM, Halperin ML. New clinical approach to evaluate disorders of potassium excretion. Miner Electrolyte Metab 1986; 12: 234-238
    PubMedGoogle Scholar
  • 23 Strauss MB, Davies RK, Rosenbaum JD, Rossmeisl EC. Water diuresis produced during recumbency by the intravenous infusion of isotonic saline solution. J Clin Invest 1951; 30: 862-868
    CrossrefPubMedGoogle Scholar
  • 24 Kirchhoff E. Online-Publication of the German Food Composition Table ‘Souci–Fachmann–Kraut’ on the Internet. J Food Comp Anal 2002; 15: 465-472
    CrossrefPubMedGoogle Scholar
  • 25 Knechtle B, Knechtle P, Rosemann T. No exercise-associated hyponatremia found in an observational field study of male ultra-marathoners participating in a 24-h ultra-run. Phys Sportsmed 2010; 38: 94-100
    CrossrefPubMedGoogle Scholar
  • 26 Chorley J, Cianca J, Divine J. . Risk factors for exercise-associated hyponatremia in non-elite marathon-runners. Clin J Sport Med 2007; 17: 471-477
    CrossrefPubMed
  • 27 Knechtle B, Knechtle P, Rosemann T, Lepers R. Predictor variables for a 100-km race time in male ultra-marathoners. Percept Mot Skills 2010; 111: 681-693
    CrossrefPubMedGoogle Scholar
  • 28 Knechtle B, Knechtle P, Rosemann T, Senn O. What is associated with race performance in male 100 km ultra-marathoners: Anthropometry, training or marathon best time?. J Sports Sci 2011; 29: 571-577
    CrossrefPubMedGoogle Scholar
  • 29 Knechtle B, Wirth A, Knechtle P, Rosemann T. Training volume and personal best time in marathon, not anthropometric parameters, are associated with performance in male 100-km ultrarunners. J Strength Cond Res 2010; 24: 604-609
    CrossrefPubMedGoogle Scholar
  • 30 Noakes TD. Hyponatremia in distance runners: fluid and sodium balance during exercise. Curr Sports Med Rep 2002; 1: 197-207
    PubMedGoogle Scholar
  • 31 Noakes T. Fluid replacement during marathon running. Clin J Sport Med 2003; 13: 309-319
    CrossrefPubMedGoogle Scholar
  • 32 Knechtle B, Knechtle P, Rosemann T. Do male 100 km ultra-marathoners overdrink?. Int J Sports Physiol Perform 2011; 6: 195-207
    PubMedGoogle Scholar
  • 33 Hew-Butler TD, Sharwood K, Collins M, Speedy D, Noakes T. Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon. Br J Sports Med 2006; 40: 255-259
    CrossrefPubMedGoogle Scholar
  • 34 Speedy DB, Thompson JM, Rodgers I, Collins M, Sharwood K, Noakes TD. Oral salt supplementation during ultradistance exercise. Clin J Sport Med 2002; 12: 279-284
    CrossrefPubMedGoogle Scholar
  • 35 Oöpik V, Timpmann S, Hackney AC, Kadak K, Medijainen L, Karelson K. Ingestion of sodium citrate suppresses aldosterone level in blood at rest and during exercise. Appl Physiol Nutr Metab 2010; 35: 278-285
    CrossrefPubMedGoogle Scholar
  • 36 Vrijens DMJ, Rehrer NJ. Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat. J Appl Physiol 1999; 86: 1847-1851
    CrossrefPubMedGoogle Scholar
  • 37 Speedy DB, Rogers IR, Noakes TD, Wright S, Thompson JM, Campbell R, Hellemans I, Kimber NE, Boswell DR, Kuttner JA, Safih S. Exercise-induced hyponatremia in ultradistance triathletes is caused by inappropriate fluid retention. Clin J Sport Med 2000; 10: 272-278
    CrossrefPubMedGoogle Scholar
  • 38 Fellmann N, Ritz P, Ribeyre J, Beaufrère B, Delaître M, Coudert J. Intracellular hyperhydration induced by a 7-day endurance race. Eur J Appl Physiol Occup Physiol 1999; 80: 353-359
    CrossrefPubMedGoogle Scholar