Coaching Today

Water: When More is Not Always Better


By Christopher D. Davis

Water: When More is Not Always Better_DBMany of us may recall our track and cross country days when we would run sprints and conditioning laps without any breaks, much less water breaks. Though this would be a legal nightmare and reckless behavior for coaches today, too much water could be just as harmful, if not fatal.

An emerging threat is on the horizon for long-distance runners and those who are dehydrated prior to rigorous sports events. The threat – exertional hyponatremia – occurs when an athlete either consumes too much fluid in a short period of time or too much sodium is lost through perspiration and not replaced.  This condition is primarily seen in distance runners, but individuals can be at risk when involved in outdoor activities, dehydrated and exercising for excessive periods of time.

In 2002, a study conducted on Boston Marathon runners found 1,900 of the nearly 15,000 finishers had some degree of hyponatremia.1  Thirteen percent had hyponatremia and three runners had critical hyponatremia, including one who died.2 

Then, there was the California woman who entered a water-drinking contest entitled “Hold your Wee for a Wii.”  Hours after participating in the contest, the woman was found dead in her apartment.3 Exertional hyponatremia may quickly become one of the most overlooked and misdiagnosed threats for coaches.

By definition, hyponatremia is when the sodium levels are low within the body.  Sweating is the body’s primary means of dissipating heat and a person can lose up to 1.8 liters of sweat per hour.  If a high amount of sweat (sodium) is lost and a high volume of water is replaced, brain cells can’t accommodate the excess fluid.   Inevitably, this leads to brain edema causing seizures, coma, brain herniation and possibly death.

So how do we help prevent athletes from hyponatremia?  Education, Prevention and Recognition. 

Education:  Most athletes and coaches are unaware that such a danger exists.  It is rarely mentioned in literature and often diagnosed as dehydration.  Educate your athletes on risks from fluid overload and encourage water intake in moderation. Check for dehydration and help them to develop a plan for prevention.  Encourage salt intake with water intake.

Prevention:  Make sure your athletes have a hydration plan in place.  As a coach, you can monitor the duration and intensity of the exercise and determine if this places your athletes at an increased risk.  Allow them to slowly acclimatize to the heat over a period of days, if training outside.  Have your athletes weigh themselves before and after an event. If an athlete has gained substantial weight, they may be at risk for fluid overload. Drink at least 500ml for every pound of weight lost.5  Don’t just drink, but eat. Pretzels are low fat, low protein, high carbohydrate and provide a great source of sodium.

Recognition:  Recognize some of the signs of hyponatremia:  altered mental status, disorientation, edema (swelling), headaches and nausea.6  Coaches are the one who know their players best.  Know the signs and symptoms of hyponatremia and when your athlete may be exhibiting these signs.

Just as a defensive coordinator must know the possible threats to his defense that can leave him exposed, it is vital that coaches know the threats that leave their athletes susceptible to illness/injury.  Take some time with your players and discuss hyponatremia and strategies for prevention.  We are beyond the days where the only tools we need are a calculator, stopwatch, traffic cones and a whistle.  We need to be aware and cognizant of the dangers encroaching upon our athletes.

At the beginning of the year, commit to setting aside five minutes at the start of every week to discuss a health topic:  Hyponatremia, Concussions, Dehydration, etc.  In doing so, you not only protect yourself legally, but you will also win the favor of the administration and parents.  This is a victory for you and your players.

  1. Almond, Christopher.  “Hyponatremia among Runners in the Boston Marathon.”  New England Journal of Medicine, 2005.  352:1550-1556.
  2. Smith, S., “Marathon runner’s death linked to excessive fluid intake.”  Boston Globe, 08/13/2002, A1.
  3. Saltzman, Sammy.  “Jennifer Strange’s Family Awarded $16.5 Million in “Wee for Wii” Contest Death.” October 2009.  CBS news. 
  4. Barry, M., and Ferraro, E.  Exertional Hyponatremia.  Korey Stringer Institute.  Retrieved on October 4, 2012: 
  5. O’Connor, R.E.  Exercise-induced hyponatremia:  causes, risks, prevention, and management.  Cleveland Clinic Journal of Medicine, 2006 Sep; 73 Suppl 3:S13-8.
  6. Goh, K.P., Management of Hyponatremia.  American Family Physician.  2004 May 15; 69(10): 2387-2394.


About the Author: Christopher Davis is recruiting manager/director of marketing at Harding University in Searcy, Arkansas.




SMI Banner Ad
Bag Tags

SMI Awards Half Skyscraper

Liberty Mutual 1

Copyright ©2011 National Federation of State High School Associations. All Rights Reserved.

National Federation of State High School Associations
PO Box 690 • Indianapolis, IN 46206 • PHONE: 317.972.6900 • FAX: 317.822.5700


  Hall Of FameiHoopsLogo2     NIAAA   Let's Move In School