Hyponatremia In Atleta
Abstract
This article aims at demonstrating, through a review of the existing bibliography, the effects of the consumption of liquids and/or solids during endurance sports, on plasma concentration of sodium and on body weight. The excessive hydration of liquids during the exercise may bring about a health complication known as hyponatremia or “water intoxication”. This pathology is known by a decrease in the concentration of the sodium in serum concentration below acceptable rates (136-145 mmol/L). The mechanism of hyponatremia is not clearly revealed. One theory defends that it is provoked by the excessive consumption of water and great losses of salt by sweat in endurance exercises leading to hyponatremic hypovolemia, the other theory argues that the excessive intake of hypotonic liquids cause hypervolemia or hyponatremia by dilution. This article was elaborated from 39 publishing’s about recommendation and discussions on hydration for athletes and about hydric reposition through water or sports drinks during exercise. On the researches analyzed data collection was done through the observation of change in individual weight before and after the endurance exercise or the rate of liquid loss, total number of glasses of liquids drank during exercise, quiz including kind of diet and medicine taken, collecting and analysis of samples of blood of the athletes. In most of the researches analyzed hyponatremia was associated to hyper hydration of the athlete, although other studies should be conducted to clarify the real cause of the hyponatremia induced by the exercise as well as a consensus about how it should be prevented in sports
References
Almond, C.S.D.; e colaboradores. Hyponatremia among runners in the Boston Marathon. New England Journal of Medicine. v.352, n.15,p.1550-1556.2005.
American College of Sports Medicine. Position Stand: Exercise and fluid replacement. Med Sci Sports Exerc., n.29, p.1-11, 1996.
Armstrong, L.E.; e colaboradores. Symtomatic hyponametria during prolonged exercise in heat. Med. Sci. Sports Exerc., v.25, p.543-549. 1993.
Baker, L.B.; Munce, T.A.; kenney W.L. Sex differences in voluntary fluid intake by older adults during exercise. Med. Sci. Sports Exerc. v.37, p. 789-796, 2005.
Barr, S.L.; Costill, D.L.; Fink, W.J. Fluid repalcement during prolonged exercise: effects of water, saline or no fluid. Med Sei. Sports Exerc., v.23, p.811-817, 1991
Bergeron, M.F. Sódio: O nutriente esquecido. GSSI, Georgia, abril/maio/junho, 2001.
Berkow, R. Manual Merk de medicina: diagnóstico e tratamento. 16ª ed., São Paulo: Roca,1995.
Carvalho, T. Modificações Dietéticas, reposição hídrica, suplementos alimentares e drogas: comprovação de ações ergogênicas e potenciais riscos à saúde. Ver. Brás. Med. Esp, v.9, n.2, mar/abril, 2003.
Casa, D.J.; Armstrong, L.E.; Hillman, S.K.; Montain, S.J.; Reiff, R.V.; Rich, B.S.; e colaboradores. National Athletic Trainer's Association Position Statement (NATA): Fluid replacement for athletes. J Athl Train. v.35, n.2, p.212-214, 2000.
Chorley, J.M.D. Risk Factors for Exercise-associated Hyponatremia en Non-elite Marathon Runner. Clin. Sport Med. v.17, n 6, p. 471-477, nov., 2007.
Costill, D.L. Sweating: its composition and effects on body fluids. Ann. N.Y. Acad. Sci. v.301, n. 160-174. 1977.
Davis, D.P.; Videen, J.S.; Marino, A.; Vike, G.M.; Dunford, J.V.; Van Camp, S.P.; Maharam, L.G. Exercise-associated hiponatremia in marathon runners: a two-year experience. J. Emerg. Med. n. 21, p.47-57, 2001.
Gardner, J.W. Death by water intoxication. Military Med, v.5, p. 432-434, 2002.
Hew, T.D.; Sharwood, K.A.; Speedy, D.B.; Noakes, T.D. Ad libitum sodium ingestion does not influence serum sodium concentrations during an Ironman triathlon. British J. of Sports Med., n.40, p.255-259, 2006.
Hew-Buther, T.D.; Almond, C.S.; Ayus, J.C.; Dugas, J.P.; Meeuwisse, W.H.; Noakes, T.D.; e colaboradores. Consensus Document of the 1st Internacional Exercise-Associated
Hyponatremia (EAH) Consensus Symposium, Cape Town, South Africa. Clin. J. of Sports Med, n.15, p. 207-213, 2005.
Hew-Buther, T.D.M.; Joseph, G.V.; Noakes, T.D. Updated Fluid Recommendation: Position Statemet From the International Marathon Medical Directors Association (IMMDA). Clin. J. of Sports Med, v.16, n.4, p. 283-292, july, 2006.
Hiller, W.D.B. Dehydration and hyponatremia during triathlons. Med. Sci. Sports Exerc. v.21, p.219-221, 1989. Hsieh, M. Recommendations for Treatment of Hyponatraemia at Endurance Events. Med Sports, v.34, n.4, p.231-238, 2004.
Jeukendrup, A.E. Carbohydrate intake during exercise and performance. Nutrition, [S.I.], v.20, p.669-677, 2004
Kapasi, I.A.M.; Albiero, K.A.; Stürner, K. Aspectos para Minimizar os Efeitos Adversos da Prática Esportiva no Calor. Rev. Nut. em Pauta, n.72, maio/jun., 2005.
MacCardle, W.D.; Katch, F.I.; Katch, V.L. Nutrição para o Desporto e o Exercício. Rio de Janeiro: ed. Guanabara Koogan, 2001.
Moreira, C.A.M.; e colaboradores. Hidratação durante o exercício: a sede é suficiente? Rev. Bras. Med. Esp., Belo Horizonte, v.12, n.6, p. 405-409, nov/dez, 2006.
Mahan, E.S., Krause: Alimentos, Nutrição e Dietoterapia. 9ª Ed.. São Paulo: Roca, 1998.
Maughan, R.J.; Susan, Shirreffs, M. & Leiper, J.B. Errors in the estimation oh hydration status from changes in body mass. J. of Sports Sci. Reino Unido, v.25, p. 797-804, 2007.
Murray, B.; Eichner, E.R.; Stofan, J. Hiponatremia em Atletas. GSSI, v.16, n1, abril/maio/junho, 2003.
Noakes, T.D. Can we trust rehydration research? In: McNamee M. Philosophy and the sciences of exercise, health and sport: critical perspectives on research methods. Routledge Press, Oxford, p.144-168, 2004.
Noakes, T.D. Sport Drinks: Prevention of “Voluntary dehydration” and development of exercise-associated hiponatremia. Med. And Sci in Sports and Exerc. v. 38, n1, p. 193-194, jan, 2006.
Noakes, T.D.; Goodwin, N.; Rayner, B.L.; e colaboradores. Water intoxication: a possible complication during endurance exercise. Med Sci Sports Exerc., v.17, n 3, p. 370-375, 1985.
Noakes, T.D. Princípios Gerais de beber no exercício: Que evidência há que atletas deveriam beber “tanto quanto o tolerável'', “para substituir o peso perdido durante o exercício'' ou “a vontade”? J. of Sports Sci., n. 25, p. 781-796, may, 2007.
Rogers, G.; Goodman, C.; Clifford, R. Water budget during ultra endurance exercise. Med Sci Sports Exerc., v.29, n.11, p.1477-1481, 1997.
Sallis, R. Colapso em atletas de endurance. GSSI, Califórnia: 2005. Disponível on-line: www.gssi.com.br > acesso em 09 de maio de 2008.
Siegel, A.J. Exercise-Associated Hyponatremia: Role of Cytokines. Amer. Journal Med., USA, v. 119, (7A) p. 74-78, july, 2006.
Speedy, D.B.; Thompson, J.M.; Rodgers, I.; Collins, M.; Sharwood, K.; Noakes, T.D. Oral salt supplementation during ultradistance exercise. Clin. J. of Sports Med., n.12, p.279-284, 2002.
Speedy, D.B.; Noakes, T.D.; Rogers, J.R.; Thompson, J.M.; Campbell, R.G.; Kuttner, J.A.; Bowstell, D.R.; Wright, S.; Hamlin, M. Hyponatremia in ultradistance athletes. Med Sci. Sports Exerc. v.31, p.809-815, 1999.
Vrijens, D.M.; Reher, N.J. Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat, J. Appl. Physiol. n.86, p.1847-1851, 1999.
Wenger, C.B. Human heat acclimatization, n: K.B. Pandolf, M.N. Sawka, and R.R.Gonzalez (eds.) Human Performance Physiology and Environmental Medicine at Terrestrial Extremes. Indianapolis, IN: Benchmark Press, p. 153 -197, 1988.
Wharam, P.C.; Speedy, D.B.; Noakes, T.D.; Thompson, J.M.D.; Reid, S.A.; Holtzhausen, L.M. NSAID Use increases the Risk of Developing Hyponatremia during an Ironman Triathlon. Med. Sci. Sports Exerc., v. 38, n. 4, p.618-622, 2006.
Zehlinger, J.C.; e colaboradores. Case series: hiponatremia associated with moderate exercise. Am. J. Med. Sci., v.311, p. 86-91, 2003.
Zambraski, E.J. The kidney and body fluid balance during exercise. In: Burskirk, E.R., Puhl, S.M. Body fluid balance: exercise and sport. Boca Raton: CRC, 1996.
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