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Medicina (Kaunas). 2019 Mar 7;55(3). pii: E63. doi: 10.3390/medicina55030063.

Exercise-Associated Hyponatremia During a Self-Paced Marathon Attempt in a 15-Year-Old Male Teenager.

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Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland.
Institute of Primary Care, University of Zurich, 8006 Zurich, Switzerland.
Institute of Primary Care, University of Zurich, 8006 Zurich, Switzerland.
Institute of Primary Care, University of Zurich, 8006 Zurich, Switzerland.
Laboratory of Exercise Testing, Hellenic Air Force Academy, 13671 Dekelia, Greece.


Background and objective: The increased participation in endurance sports such as marathon running has attracted scientific interest especially with regard to adult athletes. However, few studies have examined the impact of a marathon race on children and adolescents. Therefore, the aim of the present case study was two-fold: first, to describe pacing during a marathon race, and second, to examine acute responses of blood physiology and biochemistry parameters during the race (i.e., pre- and post-race) as well as five consecutive days after the race. Materials and Methods: Participant was a 15-year-old boy who completed a self-paced marathon attempt for the first time and finished in 5 h 19 m 53 s. Positive pacing (i.e., a running speed that decreased throughout race) with a final end spurt was observed. Results: An increase in fluid intake across race was shown. Exercise-associated hyponatremia (EAH, i.e., plasma sodium concentration <135 mmol/L) was found post-race. C-reactive protein (CRP) did not correlate either with creatine kinase (CK) (r = 0.457, p = 0.302) or with lactate dehydrogenase (LDH) (r = 0.156, p = 0.739); however, leukocytes correlated very largely with LDH (r = 0.889, p = 0.007) but not with CK (r = 0.696, p = 0.082). CK and LDH related almost perfectly with creatinine (r = 0.937, p = 0.002 and r = 0.959, p = 0.001, respectively); also, creatinine clearance correlated very largely with CK (r = -0.782, p = 0.038) but not with LDH (r = -0.733, p = 0.061). Leukocytes, aspartate aminotransferase, LDH, and CK deviated from physiological range post-race, but returned to normal values during the five-day recovery period. Conclusions: In summary, a male teenager at the age of 15 years was able to run a marathon in under 6 h without significant harmful effects on health. He developed mild and asymptomatic EAH and an increase in leucocytes, CRP, CK, and LDH as markers of inflammation and skeletal muscle damage. EAH after the marathon was resolved within one day of recovery.


adolescence; blood physiology; caloric intake; endurance; exercise-associated hyponatremia; fatigue; fluid intake; performance

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