Hyponatremia is associated with higher NT-proBNP than normonatremia after prolonged exercise

Clin J Sport Med. 2012 Nov;22(6):488-94. doi: 10.1097/JSM.0b013e3182580ce8.


Objective: To determine the incidence of and risk factors for exercise-associated hyponatremia (EAH) in cyclists completing a long-distance bike ride and to assess whether postexercise serum NT-proBNP concentration (brain natriuretic protein precursor) differed between riders with and without EAH.

Design: Observational study.

Setting: "Around the Bay in a Day" cycle event, October 2010.

Participants: One hundred thirty-nine cyclists prospectively enrolled, with 90 completing 210 or 250 km.

Main outcome measures: Body weight change and fluid intake during the event, and postevent serum sodium concentration ([Na+]) and NT-proBNP concentration ([NT-proBNP]).

Results: Four riders (4.5%) were hyponatremic ([Na+] < 135 mmol/L). The lowest postride [Na+] was 126 mmol/L. Hyponatremia was associated with a mean weight gain of 3.4 kg (3.9% of total body weight). Significant negative correlations were found between postride [Na+] and change in weight (r = -0.34; P < 0.01) and fluid intake when expressed as total volume (r = -0.35; P < 0.01), mL/kg body weight (r = 0.33; P < 0.01), mL·kg·h (r = -0.27; P < 0.01), or mL/h (r = -0.29; P < 0.01). NT-proBNP concentrations levels in 3 of the 4 hyponatremic subjects were markedly elevated compared with eunatremic subjects matched for age, sex, distance ridden, training, and medical history.

Conclusions: Exercise-associated hyponatremia was found to occur in 4.5% of the study group and was associated with weight gain during a prolonged bike ride. Postride [Na+] varied inversely with weight change and with fluid intake. Three of 4 hyponatremic riders had significant elevations of [NT-proBNP]. These results support the hypothesis that overconsumption of hypotonic fluids in this setting is the most important cause of EAH.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bicycling / physiology*
  • Drinking / physiology
  • Female
  • Humans
  • Hyponatremia / blood*
  • Hyponatremia / physiopathology*
  • Incidence
  • Male
  • Middle Aged
  • Natriuretic Peptide, C-Type / blood*
  • Prospective Studies
  • Risk Factors
  • Sodium / blood*
  • Weight Gain / physiology
  • Young Adult


  • amino-terminal pro-C-type natriuretic peptide, human
  • Natriuretic Peptide, C-Type
  • Sodium