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W. Douglas B. Hiller, MD; Mary L. O'Toole, PhD
Campbell Clinic University of Tennessee Memphis

Robert H. Laird, MD
Kailua-Kona, Hawaii

JAMA. 1986;256(2):213.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

We read with great interest the article by Frizzell et al¹ in the Feb 14 issue of JAMA. We are certainly in agreement with the authors concerning the serious nature of hyponatremia in ultraendurance athletes in whom hyponatremia is a real and potentially life-threatening problem. In our prospective study² in 1984 at the Ironman Triathlon World Championship in Hawaii, we were very surprised to find hyponatremia in 29% of the study subjects.

However, we would like to differ with one major point made in the Frizzell article and in the article by Noakes et al³ to which the authors refer. It was postulated by both Frizzell et al and Noakes et al that these hyponatremic athletes were overhydrated. The only direct evidence in support of this is the weight gain of one athlete (a 4.5-kg gain by case 4 in the Noakes et al . . . [Full Text PDF of this Article]

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