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The purpose of our article was to point out that hyponatremia is a serious life-threatening electrolyte disorder in ultramarathon runners. The likelihood of this syndrome developing in shorter-duration events appears low.Most of the published guidelines for athletes indicate the need to replace water losses without addressing salt losses. Both of the above letters are in agreement with our postulate that salt balance as well as water balance in participants of ultramarathon events should be considered.The observations of Hiller et al are consistent with our feelings. However, ultramarathon participants on foot are more likely to be water overloaded, with frequent aid stations every mile or two, than triathlon competitors, who spend the majority of the time cycling. Runners are encouraged to drink water liberally at these rest stops, whereas triathletes may find it difficult to consume equal amounts of water while cycling.There are many mechanisms leading
Lathan SR, Lowance DC, Frizzell RT. Hyponatremia and Ultramarathons-Reply. JAMA. 1986;256(2):214. doi:10.1001/jama.1986.03380020075017
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