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Rationale for Upper Limits of Electrolyte Replacement during Exercise

Fred Brouns, Wim Saris, and Heinz Schneider

The addition of carbohydrate and sodium to sport drinks has been recommended to enhance fluid intake and absorption and to delay fatigue. Other electrolytes (E) which are lost through sweating are also commonly added. However, too many E may lead to increased serum E and osmolality levels, which may negatively influence thermoregulation, depress sweating, and cause gastrointestinal distress. On the other hand, drinking large amounts of plain water to compensate sweat loss may induce hyponatremia. Therefore, literature describing sweat E losses was examined in order to estimate average whole-body E loss and to determine an upper limit for replacement of E with sport drinks. Mean E loss was determined from 13 studies, with +1 SD resulting in a hypothetical range for E losses. Correction for net absorption resulted in an upper limit of electrolyte replacement. It is suggested that the E levels in sport rehydration drinks should not exceed the upper limit of the range given.

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Exertional Hyponatremia: Considerations for the Medical Staff

Michelle A. Cleary and Douglas J. Casa

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Exertional Hyponatremia: Considerations for Athletic Trainers

Michelle A. Cleary and Douglas J. Casa

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Sweat Characteristics of Cramp-Prone and Cramp-Resistant Athletes

Kevin C. Miller, Brendon P. McDermott, and Susan W. Yeargin

 al., 2016 ) but not all ( Amano et al., 2017 ). Sweat electrolyte concentration differences may be due to SR differences, as ion absorption rates appear similar between genders ( Amano et al., 2017 ). We recommend clinicians consider gender and sport when determining fluid and electrolyte replacement needs

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Does Replacing Sodium Excreted in Sweat Attenuate the Health Benefits of Physical Activity?

Martin J. Turner and Alberto P. Avolio

International guidelines suggest limiting sodium intake to 86–100 mmol/day, but average intake exceeds 150 mmol/day. Participants in physical activities are, however, advised to increase sodium intake before, during and after exercise to ensure euhydration, replace sodium lost in sweat, speed rehydration and maintain performance. A similar range of health benefits is attributable to exercise and to reduction in sodium intake, including reductions in blood pressure (BP) and the increase of BP with age, reduced risk of stroke and other cardiovascular diseases, and reduced risk of osteoporosis and dementia. Sweat typically contains 40–60 mmol/L of sodium, leading to approximately 20–90 mmol of sodium lost in one exercise session with sweat rates of 0.5–1.5 L/h. Reductions in sodium intake of 20–90 mmol/day have been associated with substantial health benefits. Homeostatic systems reduce sweat sodium as low as 3–10 mmol/L to prevent excessive sodium loss. “Salty sweaters” may be individuals with high sodium intake who perpetuate their “salty sweat” condition by continual replacement of sodium excreted in sweat. Studies of prolonged high intensity exercise in hot environments suggest that sodium supplementation is not necessary to prevent hyponatremia during exercise lasting up to 6 hr. We examine the novel hypothesis that sodium excreted in sweat during physical activity offsets a significant fraction of excess dietary sodium, and hence may contribute part of the health benefits of exercise. Replacing sodium lost in sweat during exercise may improve physical performance, but may attenuate the long-term health benefits of exercise.

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Certified Athletic Trainers' Perceptions of Exercise-Associated Muscle Cramps

Marcus B. Stone, Jeffrey E. Edwards, Catherine L. Stemmans, Christopher D. Ingersoll, Riann M. Palmieri, and B. Andrew Krause


Despite recent evidence to suggest that exercise-associated muscle cramps (EAMC) might be primarily of neuromuscular origin, the authors surmise that most information available to certified athletic trainers (ATCs) emphasizes the role of dehydration and electrolyte imbalance in EAMC.


To investigate ATCs' perceptions of EAMC.


7-question, Web-based, descriptive, cross-sectional survey.


997 ATCs.

Main Outcome Measures:

Responses to 7 questions regarding the cause, treatment, and prevention of EAMC.


Responders indicated humidity, temperature, training, dehydration, and electrolyte imbalance as causative factors of EAMC. Fluid replacement and stretching the involved muscle were identified as very successful in treating and preventing EAMC. Proper nutrition and electrolyte replacement were also perceived as extremely successful prevention strategies.


ATCs' perceptions of the cause, treatment, and prevention of EAMC are primarily centered on dehydration and electrolyte imbalance. Other prominent ideas concerning EAMC should be implemented in athletic training education.

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Sweat Sodium, Potassium, and Chloride Concentrations Analyzed Same Day as Collection Versus After 7 Days Storage in a Range of Temperatures

Lindsay B. Baker, Kelly A. Barnes, Bridget C. Sopeña, Ryan P. Nuccio, Adam J. Reimel, and Corey T. Ungaro

,104 versus 1,352 mg/hr of Na + lost during exercise. Fluid/electrolyte replacement strategies for athletes ( Sawka et al., 2007 ; Thomas et al., 2016 ) likely will not differ significantly between these two scenarios. When high accuracy is required, such as during laboratory research and electrolyte

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Collegiate and Professional Ice Hockey Athletic Trainers’ Hydration Practices and Knowledge: Part 1

Dawn M. Emerson, Toni M. Torres-McGehee, Susan W. Yeargin, Kyle Dolan, and Kelcey K. deWeber

had adequate access), may choose to provide more dietary recommendations, or they do not perceive issues within their team(s) that requires supplements. Because ice hockey athletes are less likely to drink sports drinks during practice, 2 , 4 electrolyte replacement may be warranted for those at risk

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Sweating Rate and Sweat Chloride Concentration of Elite Male Basketball Players Measured With a Wearable Microfluidic Device Versus the Standard Absorbent Patch Method

Lindsay B. Baker, Michelle A. King, David M. Keyes, Shyretha D. Brown, Megan D. Engel, Melissa S. Seib, Alexander J. Aranyosi, and Roozbeh Ghaffari

, while no reliable assay is available for sodium. Since most electrolyte replacement guidelines are centered around sodium, the smartphone application associated with the microfluidic patch converts local sweat [Cl − ] to whole-body sweat [Na + ]. This conversion uses regression equations developed from

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Hydrothermally Modified Corn Starch Ingestion Attenuates Soccer Skill Performance Decrements in the Second Half of a Simulated Soccer Match

Manuel D. Quinones and Peter W.R. Lemon

guidelines ( American College of Sports Medicine, 2017 ). The electrolyte concentration in both beverages was the same and controlled using a noncaloric flavored electrolyte replacement powder (UCAN Hydrate ® , Woodbridge, CT) that contained 94 mg/L of magnesium, 282 mg/L of chloride, 563 mg/L of sodium, 188