Statement of the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015 Tamara Hew-Butler, 1 Mitchell H Rosner, 2 Sandra Fowkes-Godek, 3 Jonathan P Dugas, 4 Martin D Hoffman, 5 Douglas P Lewis, 6 Ronald J Maughan, 7 Kevin C Miller, 8 Scott J Montain, 9 Nancy J Rehrer, 10 William O Roberts, 11 Ian R Rogers, 12 Arthur J Siegel, 13 Kristin J Stuempfle, 14 James M Winger, 15 Joseph G Verbalis 16 For numbered affiliations see end of article. Correspondence to Dr Tamara Hew-Butler, DPM, PhD, School of Health Science, Oakland University, Rochester, MI 48309-4482, USA; hew@oakland.edu Accepted 16 May 2015 To cite: Hew-Butler T, Rosner MH, Fowkes- Godek S, et al. Br J Sports Med Published Online First: [ please include Day Month Year] doi:10.1136/bjsports- 2015-095004 INTRODUCTION The 3rd International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California, in February 2015, with a panel of 17 international experts. The delegates represented four countries and nine medical and scientific subspecialties per- taining to athletic training, exercise physiology, sports medicine, water/sodium metabolism and body fluid homoeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus Statement. 1 This docu- ment serves to replace the 2nd International EAH Consensus Development Conference Statement and launch an educational campaign designed to address the morbidity and mortality associated with a preventable and treatable fluid imbalance. The following statement is a summary of the data synthesised by the 2015 EAH Consensus Panel and represents an evolution of the most current knowl- edge on EAH. This document will summarise the most current information on the prevalence, aeti- ology, diagnosis, treatment and prevention of EAH for medical personnel, athletes, athletic trainers and the greater public. The EAH Consensus Panel strove to clearly articulate what we agreed on, did not agree on and did not know, including minority view- points that were supported by clinical experience and experimental data. Further updates will be necessary to: (1) remain current with our under- standing and (2) critically assess the effectiveness of our present recommendations. Suggestions for future research and educational strategies to reduce the incidence and prevalence of EAH are provided at the end of the document; areas of controversy that remain in this topic have also been outlined. CONSENSUS METHODOLOGY The 3rd International EAH Consensus Development Conference utilised National Institutes of Health guidelines, amended for a more holistic approach to fit the needs of both the group and the topic. Twenty-two individuals (17 accepted) were invited to participate in the consensus conference who: (1) have made scientific and/or clinical contributions to the topic of water and sodium homoeostasis, and/or hyponatraemia; and (2) represented a specific group (eg, nephrology, endurance medicine, etc) or had unique topical expertise (eg, cystic fibrosis (CF), muscle cramps, fluid balance, etc). The present document is intended to serve as the scientific record of the conference with intent to widely disseminate this information to achieve maximum impact on both current healthcare practice and future medical research. The methodology governing the conduct of this consensus development conference is summarised below. ▸ A broad-based expert panel was assembled. Panel members included researchers and clinicians in endocrinology ( JGV), nephrology (MHR), emer- gency medicine (IRR), family medicine (WOR, JMWand DPL), internal medicine (AJS), physical medicine and rehabilitation (MDH), sports medi- cine (WOR, JMW and DPL), athletic training (SF-G and KCM) and exercise physiology (JPD, SF-G, TH-B, MDH, RJM, SJM, NJR and KJS). ▸ These experts presented data on EAH in a day long public session, followed by open question/ answer and discussion periods with the audience. The panel members met the following day in a closed session to prepare the consensus statement. ▸ Workgroups were created 3months prior to the February 2015 meeting to update the following EAH target areas: epidemiology, aetiology and pathophysiology, diagnosis, treatment and pre- vention. Each workgroup was asked to present updated drafts for discussion during the closed session. ▸ A systematic, comprehensive and updated litera- ture review was shared by the panel members prior to the February 2015 meeting, using a cloud storage service that was organised into workgroup categories (epidemiology, aetiology and pathophysiology, diagnosis, treatment and prevention). All panel members had unlimited access to the cloud storage service and could add digital versions of published manuscripts to the EAH manuscript section at any time. The panel chairperson (MHR) was responsible for monitoring the progress of each work group, directing the closed session and guiding the panel’s deliberations. Using the previous two EAH consen- sus statements as a starting point, each work group was asked to: (1) incorporate new data into each assigned section and (2) update any outdated infor- mation. All recommendations were graded based on clinical strength, using the grading scale described by the American College of Chest Physicians (table 1). 2 Particular emphasis was placed on Hew-Butler T, et al. Br J Sports Med 2015;0:1–15. doi:10.1136/bjsports-2015-095004 1 Consensus statement BJSM Online First, published on July 30, 2015 as 10.1136/bjsports-2015-095004 Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on November 7, 2016 - Published by http://bjsm.bmj.com/ Downloaded from