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The incidence of exercise-associated hyponatraemia in the London marathon
  1. Courtney Kipps1,
  2. Sanjay Sharma2,
  3. Dan Tunstall Pedoe3
  1. 1London Marathon and Specialty Trainee in Sport and Exercise Medicine, Charing Cross Hospital and Queen Mary, University of London, London, UK
  2. 2London Marathon and Consultant Cardiologist, Kings College Hospital, London, UK
  3. 3London Marathon and Retired Consultant Cardiologist, Homerton Hospital, London, UK
  1. Correspondence to Dr Courtney Kipps, 20 Elsenham Street, London, UK; courtneykipps{at}


Background Exercise-associated hyponatraemia (EAH) is a potentially fatal cause of collapse in endurance exercise. It is understood to be a dilutional hyponatraemia caused by an increase of total body water relative to the amount of exchangeable sodium stores. Fourteen runners presented to one London hospital with symptomatic EAH several hours after finishing the 2003 London Marathon, and more recently, a young male runner died from the complications of severe EAH after crossing the finish line of the London Marathon.

Objectives To determine the incidence of EAH in runners in the London Marathon.

Methods Volunteers were recruited at race registration where they were weighed, had blood tests and completed a demographic and experience questionnaire. Weights, blood tests and a fluid intake questionnaire were repeated after the finish. Blood was analysed on-site using hand-held i-STAT blood analysers.

Results Of the 88 volunteers, 11 (12.5%) developed asymptomatic hyponatraemia (serum sodium 128–134 mmol/l). They consumed more fluid (p<0.001) and gained more weight (p<0.001) than did those without hyponatraemia.

Conclusions A significant proportion (12.5%) of healthy volunteers developed asymptomatic hyponatraemia running a marathon in cool conditions. On average, these runners consumed more fluid and gained more weight than did non-hyponatraemic runners, although fluid intake was not related to weight gain in this study. Four of the 11 hyponatraemic runners lost weight over the course of the marathon, strengthening the case for an additional factor, such as inappropriate antidiuretic hormone release during exercise, in the development of EAH.

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  • Funding Abbott Point of Care supplied the i-STAT blood analysers and cartridges for this study.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the East London and the City Research Ethics Committee 3.

  • Patient consent Obtained.