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Fluid-sodium imbalance can be life-threatening

Lisa Liddane - Orange County Register

It's a rare condition that's been getting a louder buzz this year. 

Hyponatremia. 

This occurs when endurance athletes drink too much fluid, causing the sodium levels in the blood to drop to potentially dangerous levels. 

Athletes experience symptoms similar to dehydration: They become confused and disoriented. They may feel nauseated, vomit and experience headache, muscle cramps or muscle weakness. 

Complications of severe hyponatremia include swelling in the brain and lungs, which can result in seizure, coma or heart attack. Deaths have occurred when sodium levels dropped drastically. 

The noise about hyponatremia has become loud enough that the American College of Sports Medicine addressed it in a recent report, to separate hype from fact. An international panel of hydration experts examined the best available evidence on hydration and physical activity and released guidelines. 

How common is it? Hyponatremia is relatively rare. In marathons and triathlons, the incidence is low --- less than one in 1,000 finishers. But it's been found to be higher in isolated ultradistance races --- 40 to 50 in 1,000 finishers. 

Who's at greater risk? Slow-paced athletes, such as those who run longer than four hours or participate in triathlons longer than nine to 13 hours. They appear to make more stops to drink at water stations and drink more. Women seem to be at higher risk because they drink more fluids than they lose while sweating, and their smaller body mass may be more easily affected by excess fluids. 

How does it occur? When athletes drink too much fluid, or through a combination of too much fluid intake and high sodium loss through sweat. 

How can you prevent it? Appropriate fluid intake (before, during and after exercise) helps regulate your body temperature and replace fluids lost in sweat. 

Know how much fluid you lose through sweat. First, weigh yourself (preferably sans clothes and shoes) before and immediately after an hour of strenuous activity. Get the difference between the two measurements. Multiply it by 16 to convert pounds to ounces. This is what you need every hour to replenish your fluids. 

If you're feeling symptoms of hyponatremia, ask for help if you're training or competing in a race. 

If you're participating in physical activity lasting more than three to four hours, eat salted snacks and drink sports beverages that contain electrolytes. 

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