Drinking Too Much Water (Hyponatremia): What You Need to Know

Hyponatremia, or drinking too much water, is a rare but severe condition that can result in death. This condition happens when the body's cells are deprived of the proper amount of sodium, which has significant consequences for athletes. Here are some amazing things to know about this issue.

Sodium is pivotal for maintaining proper blood pressure. It also helps maintain fluid balance by preventing dehydration, which is why it's essential for survival outside the womb and during physical exertion. The body's need for sodium is higher than estimated due to a combination of factors, including a diet rich in processed foods with added salt and modern living conditions that are often too dry to prevent exercise-related dehydration.

In extreme cases, athletes with hyponatremia can pass out or die due to potentially fatal brain swelling. The condition is sometimes referred to as 'salty death' because of the high sodium content in sweat and the increased risk of death when water is consumed in excess.

People who overdrink liquids risk losing significant amounts of sodium from their systems. People drinking large quantities of water for 24 hours will lose about 2 pints (about half a gallon) of water from their systems. Drinking that same volume of water in just one hour can result in a dangerous imbalance in the body's sodium levels. This is because it takes about 10-15 minutes for your body to make sure you have enough sodium to meet your needs, and if you drink too much water before, then your body doesn't have time to do so.

Many athletes drink large amounts of fluid during and after exercise, exacerbating the problem. The good news is that you don't lose body sodium when you sweat, so you can limit the risk of hyponatremia by not drinking more than you lose through sweat.

It's estimated that at most levels of training and performance, athletes who drink enough fluids to prevent dehydration during exercise will also avoid hyponatremia. Because most athletes don't lose a harmful amount of water and electrolytes, there's no need for special treatment or additional intake beyond what's needed to maintain good health. For competitive athletes or others who put extreme demands on their bodies, consuming extra fluids may make sense to protect against dehydration.

Some Tips to Avoid Hyponatremia

  • If you are thirsty, drink. Hydrate before your thirst kicks in.

  • Don't rely on thirst to tell you when to drink. If you are sweating, drinking, and eating salty foods, it's possible that your body may need more water than your natural thirst signals.

  • Don't force yourself to drink more than 16 ounces (one pint) of fluid every 15-20 minutes during physical activity or competition at a temperature above 90 degrees F (32ÂșC). Rely on your thirst signal to know how much water is left in it so you know how much more you can drink without exceeding the maximum limit.

  • Consider your fluid intake 24 hours before an intense activity or competition. If you consumed a lot of fluid, wait until after the activity to consume more, and make it mostly water.

  • Don't think more is better regarding how much you drink after a workout or event. With exercise-induced dehydration, your body is already trying to get back to its 'normal' state; overdrinking can lead to hyponatremia, which could be life-threatening if it results in brain swelling.

  • As soon as possible, after intense physical activity, take some salt and ensure that you consume food rather than just fluids.

  • When traveling, check your sodium levels before and during any activity with a dehydration risk. If you notice any signs of hyponatremia (headache, nausea, vomiting, dizziness), drink extra water and sodium to replace what was lost before exercising again.

  • Follow the 7-day test after intense physical activity or competition to ensure you're not too dehydrated and at risk of hyponatremia.

  • Don't overhydrate after being inactive for a long time, such as missing several training days or competitive events.

  • Don't overhydrate after excessive sweating in hot weather.

Other things you should know about Hyponatremia

You may have an excessive amount of sodium present in the body. This is a serious situation that can be handled medically. Instead of dehydrating, hyponatremia is brought on by drinking too much water. Because doing so could throw your body's natural chemistry out of whack. Still, hyponatremia happens when you take in a lot of fluid and lose a reasonable amount of liquid (insensible losses like sweating), resulting in too much water entering the bloodstream or when you drink too much water to replace what was lost during physical activity, particularly with the modern tendency to under consume fluids during exercise (often with sports drinks).

Hyponatremia treatment includes drinking a sodium chloride solution or taking a drug that increases sodium levels and fluid retention (saline administration). If water intake has stopped, this could be done by giving an enema and putting the person in a room with higher air pressure. If severe, it may require dialysis.

Hyponatremia has been reported in an estimated 1% to 2% of marathon runners, triathletes, other endurance athletes, and cross-country skiers. About 16% of people who died from hyponatremia while participating in a sports event also had asthma and often used inhalers during exercise. Multisport athletes with asthma doing more than one sport have been reported to suffer more frequently from hyponatremia.

Hyponatremia occurs in the range of one-third of endurance athletes at elite levels competing in the hot conditions found in marathons and triathlons and is most common during short sprint events such as track races. It is also common among cyclists, swimmers, runners, rowers, and other endurance athletes who drink two to three non-electrolyte sports drinks or gels per hour as part of their routine. The key risk factors for developing hyponatremia are excessive consumption of water or artificially sweetened drinks and replacing sodium lost by sweating.


Concludingly, ensure you are safe and responsible for water consumption. If in doubt, rehydrate before you're thirsty, and don't overdo it, especially if you're an athlete competing in a heatwave.

Updated on: 15-Feb-2023


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