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http://fashiontuesday.tripod.com/ INTRODUCTION Hyponatraemia by definition means low (hypo) sodium (Na) in the blood (emia), (Benardot, 2006). Mild hyponatraemia results from a serum sodium concentration below 135 mmol/L, while a serum sodium concentration below 125 mmol/L triggers severe hyponatraemia (McArdle, Katch & Katch, 2006). As serum sodium concentrations drop, fluid will leave the bloodstream by osmosis and accumulate in tissues, causing swelling i.e. cellular edema. If nerve cells swell too much they cease to function properly. Therefore, although cellular edema is well tolerated by many of the body?€?s tissues, it is not well tolerated by the brain (Smolin & Grosvenor, 2008; Dunford & Doyle, 2008). Consequently, the serious symptoms of hyponatraemia are mainly related to cerebral edema and include mild symptoms of headaches, confusion, nausea and cramping; to severe symptoms of seizures, coma, pulmonary edema, cardiac arrest and death (McArdle et al., 2006; Benardot, 2006). There are a number of speculated causes of hyponatraemia in athletes. One is known as the syndrome of inappropriate antidiuretic hormone response (SIADH) which causes decreased urine production and increased fluid retention during fluid overload. But by far the most common factor in hyponatraemia is excessive drinking (Murray, Stofan, & Eichner, 2003). Rates of occurrence vary from 0-0.4% of finishers in case-based publications, to as high as 1.3% of finishers in cohort study populations (Chorley, 2007). The reported incidence of hyponatraemia in ultra-endurance events lasting over 6 hours ranges from 0.3-27%. This incidence is even higher among athletes requiring medical attention, ranging from 9-60% (Hsieh, 2004). In a study of more than 18 000 ultra-endurance runners, approximately 9% of collapsed individuals presented with symptoms of hyponatraemia (Noakes et al., 1990, as cited by McArdle et al., 2005). Death is a rare occurrence with only nine cases reported worldwide since 1985 (Carter, 2008). However, there is still some debate in regards to some of the reported incidences, as some of these studies had incorporated biased subject selection into their methodologies. An example of this is the selection of subjects based on showing possible signs of hyponatraemia upon finishing their event, potentially leading to an overestimated population (Carter, 2008). The purpose of this literature review is to review recently published scientific research to evaluate the importance of the factors involved, and to possibly identify any further factors that may increase the risk of developing hyponatraemia. The strengths and weaknesses of the reviewed studies will be discussed, before conclusions are drawn and recommendations made to athletes on how to avoid or lessen the chance of developing hyponatraemia.
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