{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:14:36Z","timestamp":1787724876807,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Scandinavian Med Sci Sports"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Exercise\u2010associated hyponatremia (EAH) is common in ultra\u2010endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra\u2010endurance competitions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medical records with sodium concentrations (<jats:italic>n<\/jats:italic>\u2009=\u20093138) from the IRONMAN\u00ae World Championships over the timeframe of 1989\u20132019 were reviewed for both male (<jats:italic>n<\/jats:italic>\u2009=\u20092253) and female (<jats:italic>n<\/jats:italic>\u2009=\u2009885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Altered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life\u2010threatening complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/sms.14401","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T11:11:02Z","timestamp":1684494662000},"page":"1841-1849","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Clinical presentation of exercise\u2010associated hyponatremia in male and female <scp>IRONMAN<\/scp>\u00ae triathletes over three decades"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-069X","authenticated-orcid":false,"given":"Kasey B.","family":"Johnson","sequence":"first","affiliation":[{"name":"Elson S. Floyd College of Medicine Washington State University  Spokane WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Connolly","sequence":"additional","affiliation":[{"name":"College of Education Washington State University  Pullman WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie P.","family":"Cho","sequence":"additional","affiliation":[{"name":"College of Education Washington State University  Pullman WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas K.","family":"Miller","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine  Roanoke Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Sallis","sequence":"additional","affiliation":[{"name":"UC Riverside School of Medicine  Riverside California USA"},{"name":"Kaiser Permanente, Sports Medicine  Fontana California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Douglas B.","family":"Hiller","sequence":"additional","affiliation":[{"name":"Elson S. Floyd College of Medicine Washington State University  Spokane WA USA"},{"name":"John A. Burns College of Medicine at University of Hawai'i  Honolulu Hawaii USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2017.00021"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm3041258"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000493247"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2009.03.001"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02730806"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina55090537"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.12.041"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(94)90057-4"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200001000-00010"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-011-2070-5"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200301000-00008"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu10121995"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-198506000-00012"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000221"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2019.11.003"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199906000-00008"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200010000-00009"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.jsm.0000174702.23983.41"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043901"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000210209.40694.09"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00502.2007"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.jsm.0000157652.47572.56"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0509096102"}],"container-title":["Scandinavian Journal of Medicine &amp; Science in Sports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sms.14401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T15:09:59Z","timestamp":1693408199000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/sms.14401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,19]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/sms.14401"],"URL":"https:\/\/doi.org\/10.1111\/sms.14401","archive":["Portico"],"relation":{},"ISSN":["0905-7188","1600-0838"],"issn-type":[{"value":"0905-7188","type":"print"},{"value":"1600-0838","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,19]]},"assertion":[{"value":"2023-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}