Running With Hyponatremia
by Cindy Hanna

Hyponatremia emerges to the forefront as a substantiated cause of death and life-threatening illness among marathon runners.  In 2002, a sample group of Boston Marathon runners was tested for signs of hyponatremia.  Blood samples from 488 runners were collected several days before the race and compared against samples taken from them at the finish line.  According to Dr. Marvin Adner, the medical director of the Boston Marathon, of those tested, “13% (62 runners) were hyponatremic, with three additional individuals at risk of dying from hyponatremia.”

While running my twenty mile training run on Sunday, December 17, 2006, through the cities of Claremont, Montclair, and Upland. I suffered serious complications associated with hyponatremia (a condition that occurs when plasma sodium levels fall dangerously below normal, causing water intoxication).

I consumed a package of energy gel around mile six. By mile ten, my hands were swollen badly and numb. Although feeling fatigued and physically ill, I continued running, consuming another energy gel at mile eleven.  By mile thirteen, my hands were completely numb and swollen to twice their normal size. I was sweating twice as much as usual, every muscle was screaming at me, and I was having difficulty regulating my breathing.   Continuing on was brutal.  Eighteen and a half miles in, I began to wonder if I might be suffering from hyponatremia.  I couldn't think clearly for more than a few seconds and was in serious pain.  By mile nineteen, I was in complete shock, shaking violently, unable to feel my hands or move my fingers, and stopped running.  Wrapping myself in a blanket, I attempted to get warm.  It took the remainder of that day for me to recover.

Athletes who train for endurance events such as marathons, Triathlons, and Iron Man competitions are at greater risk of experiencing hyponatremia, which has two causes:

• Consumption of too much fluid over too short a time span
• Inordinate sodium loss through sweating

According to Karen Ghiron, a certified Fitness Consultant and trainer with a BS in Exercise Science, “If you are consuming too much water and not enough electrolytes, your body can’t use the water you’ve given it, and you’ll actually be dehydrated while you’re virtually drowning your body.” 

Mindy Solkin, a USA Track and Field (USATF) Level III Running Coach (the highest level) and American Council on Exercise certified personal trainer, adds, “Smaller runners are more at risk, therefore many women should take extra care.  In addition, women lose more sodium than men and they start out with about ten percent less body water.  During a race, urine production decreases twenty to sixty percent due to a decrease in blood flow to the kidneys, as it is redirected to the working muscles.  If you’re especially nervous or running in hot weather, the decrease will be on the higher end of this estimate.”

The following symptoms might be early signs that you are hyponatremic:

• Feeling bloated, followed by nausea and vomiting. 
• High blood pressure and headache usually come next. 
• In more extreme cases, you might feel restless, lethargic, and confused.  At this level, respiratory distress and seizures may occur, with the most advanced stages including coma and possible death.

There are precautions you can take before and during a race to avoid experiencing hyponatremia.

• Introduce energy gels during longer training runs to ascertain how your body will react to them.
• Know your body extremely well and the warning signals it sends to you.
• Drink small amounts of fluids to stay hydrated.
•  Consume electrolytes through sports drinks, which have sodium and potassium.
• Ask the race director what fluids will be provided along the race route.
• Alternate water and hot clear chicken broth to get both water and salt.
• Tomato-based drinks include high sodium content.
• Salt tablets should not be used unless you have used them before, know a safe dosage, and know how your body will tolerate them.
• Avoid taking aspirin, acetaminophen or ibuprofen during the race, as it may affect kidney function.
• Avoid using cold remedies or decongestants during the race, as they may cause you to become dehydrated.
• Review warning signs of hyponatremia before running distances greater than eight miles. 

As Karen Ghiron points out, “If you have the symptoms of hyponatremia, chances are good that you’ll either be unable to communicate that, or unable to know you’re in trouble.”  While unable to maintain a train of thought for more than a few seconds on my run, due to hyponatremia; I knew my body well enough to ascertain that something was terribly wrong and stopped running, since my hands were swollen, which doesn’t happen when I run.

Hyponatremia is a serious medical condition, which can be fatal if ignored.  Listen when your body warns that something is wrong and cease running, no matter how stubborn you are.  Remember, if you are informed and adhere to the signals your body sends to you, you can always run another day.

Additional information on hyponatremia can be obtained by contacting:
Karen Ghiron at:
www.WellnessWorksInc.com
or
Mindy Solkin at:
www.TheRunningCenter.com