Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia

Wilderness Environ Med. 2013 Sep;24(3):228-40. doi: 10.1016/j.wem.2013.01.011. Epub 2013 Apr 13.


Exercise-associated hyponatremia (EAH) typically occurs during or up to 24 hours after prolonged physical activity, and is defined by a serum or plasma sodium concentration below the normal reference range of 135 mEq/L. It is also reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited or often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.

Keywords: SIADH; arginine vasopressin; exercise; exercise-associated hyponatremia; hyponatremia.

Publication types

  • Practice Guideline
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Algorithms
  • Brain Edema / diagnosis
  • Exercise*
  • Humans
  • Hyponatremia / prevention & control*
  • Hyponatremia / therapy*
  • Practice Patterns, Physicians'
  • Pulmonary Edema / diagnosis
  • Saline Solution, Hypertonic / therapeutic use
  • Societies, Medical
  • Sodium / administration & dosage
  • Sodium / blood
  • Sodium / therapeutic use*
  • Water / adverse effects
  • Wilderness Medicine / standards*


  • Saline Solution, Hypertonic
  • Water
  • Sodium