Nearly a decade ago, the perils of over-hydration during exercise were confirmed in two seminal studies performed on 488 Boston Marathon runners 8 and 2,135 endurance athletes 7.
Although severely symptomatic hyponatremia is relatively rare, the evidence supports that death from EAH is avoidable if athletes adhere to rational hydration strategies and avoid excessive and unneeded fluid intake 7. The single greatest risk factor for EAH and its associated complications is over-hydration 4. All EAH deaths are tragic because they are unnecessary and preventable. The recent and tragic deaths of two otherwise healthy 17-year old high school football players from hyponatremic encephalopathy 5,6, underscores the need for more education towards translating evidenced-based science into clinical practice. Exercise-associated hyponatremia (EAH) is rarely mentioned alongside the “big three”, despite its insidious extension into more diverse sporting events beyond the ultramarathon, where it was first described three decades ago 4. When we hear about catastrophic injury and death amongst athletes, we typically think about concussion 1, cardiac arrest 2 and exertional heatstroke 3.
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