Case series: Hyponatremia associated with moderate exercise

Julian Zelingher, Chaim Putterman*, Yaron Ilan, Eldad J. Dann, Fabio Zveibil, Yigal Shvil, Eithan Galun

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Exercise-induced hyponatremia is commonly believed to be associated only with extraordinary physical efforts, or particularly strenuous exercise. Hyponatremia complicating moderate exercise has not been described previously. The authors describe the characteristics of seven patients with life-threatening hyponatremia associated with mild to moderate exercise. All patients suffered from nausea, vomiting, agitation, and confusion, appearing during or after moderate physical activity. Grand real convulsions occurred in five of the patients. In laboratory results, hyponatremia was as low as 115 mEq/L, with a relatively high sodium concentration in the urine. High serum creatine kinase activity levels were found in most of the patients. All patients were discharged in good condition, without neurologic sequela. The authors conclude that hyponatremia is a possible complication of moderate exercise, and not only of endurance sports, and that exercise-induced hyponatremia can produce severe neurologic manifestations. The mechanism of the hyponatremia is unclear, but may be due to a hemodynamically inappropriate stimulus for antidiuretic hormone secretion.

Original languageAmerican English
Pages (from-to)86-91
Number of pages6
JournalAmerican Journal of the Medical Sciences
Issue number2
StatePublished - Feb 1996
Externally publishedYes

Bibliographical note

Funding Information:
From the *Division of Internal Medicine and §Department of Pediatrics, Hadassah University Hospital-Ein Kerem, Jerusalem, Israel, the Vntensive Care Unit, Western Galilee Regianal Hospital, Nahariya, Israel, and the tDepartment of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York. Supported in part by the United Israel Appeal, Canada Branch. Submitted August 14, 1995, and accepted for publication in revised form September 13, 1995. Correspondence: Chaim Putterman, MD, Department of Microbiology and Immunology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461.


  • Exercise
  • Hyponatremia
  • Inappropriate antidiuretic hormone secretion
  • Rhabdomyolysis


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