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==Symptoms==Initial In athletes, mild Hyponatremia may have no clinical symptoms tend to be a gain in weight and a general swelling and 'puffiness', most noticeable in the hands. More or weakness, dizziness, headache, nausea/vomiting, but more severe Hyponatremia is likely to have symptoms are caused by a swelling of the brain (cerebral edema) , including [[Nausea|nausea]]altered mental status, seizures, pulmonary edema, vomitingcoma, headache and malaise death<ref name="ref10RosnerKirven2006"/>. The link between Hyponatremia and [[Cramps]] is not clear, but there is evidence that increased sodium intake can alleviate both problems. ==Causes==

# Excessive water intake can cause 'dilutional Hyponatremia'<ref name="ref1RosnerKirven2006"/>. Healthy kidneys can excrete about 2 pints (1 liter) of fluid per hour, but this may be reduced by exertion or illness <ref name="ref3"/>. So drinking &gt;6 pints in 4 hours could easily exceed the kidneys capacity to cope. The recent rise in Hyponatremia may be due to earlier advice to athletes to "drink as much as possible" <ref name="ref13"/>, combined with a general concern about salt intake.

# [http://en.wikipedia.org/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_hypersecretion Syndrome Of Inappropriate Antidiuretic Hormone Hypersecretion], or (SIADH, ) is where the body secretes too much of the hormone (vasopressin) that reduces the urine output of the kidney. It's not clear if this is an independent cause of hyponatremia, or if this is a mechanism underlying one of the other causes. However, some research<ref name="siadhSiegelVerbalis2007"/> suggests that many cases of Hyponatremia are due to SIADH caused by a combination of over hydration, NSAID usage and Rhabdomyolysis. One key aspect of SIADH is that because it prevents urine production, people mistakenly assume that they are not urinating due to dehydration and drink even more.  ==Likelyhood==

* In a 1997 Ironman triathlon, almost 4% of competitors received attention for Hyponatremia <ref name="ref4"/>. * In a study of the 2002 Boston Marathon, 13% of finishers had some level of Hyponatremia, and 0.6% had critical Hyponatremia <ref name="ref2Almond-2005"/>. * In the Houston marathon<ref name="Houston"/>, 21 runners who received medical help were suffering from Hyponatremia. Runners with Hyponatremia were generally slower and drank more. * However, a study<ref name="nzmarathon"/> of the 2002 Christchurch Marathon in New Zealand, where aggressive hydration was not recommended, none of the 134 runners measured had Hyponatremia. ==Risk Factors==

* A slow finish time (&gt;4 hour)

* BAA suggests a 'slight build' is also a risk factor ==Preventing Hyponatremia==

 == References ==

<ref name="ref1RosnerKirven2006">M. H. Rosner, J. Kirven, Exercise-Associated Hyponatremia[http://cjasn.asnjournals.org/cgi/content/abstract/, Clinical Journal of the American Society of Nephrology, volume 2/, issue 1/151 , 2006, pages 151–161, ISSN [http://cjasnwww.asnjournalsworldcat.org/cgiissn/content/abstract/2/1/1511555-9041 1555-9041]</ref> <ref name="ref10">Hyponatremia, doi [http://endx.wikipediadoi.org/wiki/Hyponatremia http:10.2215//enCJN.wikipedia02730806 10.org2215/wiki/HyponatremiaCJN.02730806]</ref> <ref name="ref2Almond-2005">CS. Almond, AY. Shin, EB. Fortescue, RC. Mannix, D. Wypij, BA. Binstadt, CN. Duncan, DP. Olson, AE. Salerno, Hyponatremia among Runners runners in the Boston Marathon., N Engl J Med, volume 352, issue 15, pages 1550-6, Apr 2005, doi [http://contentdx.nejmdoi.org/cgi10.1056/contentNEJMoa043901 10.1056/NEJMoa043901], PMID [http:/abstract/352www.ncbi.nlm.nih.gov/15pubmed/155015829535 15829535]</ref> 

 <ref name="siadhSiegelVerbalis2007"> Arthur J. Siegel, Joseph G. Verbalis, Stephen Clement, Jack H. Mendelson, Nancy K. Mello, Marvin Adner, Terry Shirey, Julie Glowacki, Elizabeth Lee-Lewandrowski, Kent B. Lewandrowski, Hyponatremia in Marathon Runners due to Inappropriate Arginine Vasopressin Secretion, The American Journal of Medicine, volume 120, issue 5, 2007, pages 461.e11–461.e17, ISSN [http://www.sciencedirectworldcat.comorg/issn/00029343 00029343], doi [http://sciencedx.doi.org/article10.1016/piij.amjmed.2006.10.027 10.1016/S0002934307001672j.amjmed.2006.10.027]</ref>