Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study

Ultra-trail events (UTs) pose significant challenges to maintaining hydration and electrolyte balance, with risks of dehydration (DH), overhydration (OH), exercise-associated hyponatremia (EAH), and exertional rhabdomyolysis (ER). This study examined the effects of ad libitum (ADL) hydration on hydr...

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Main Authors: Alejandro García-Giménez, Francisco Pradas, Miguel Lecina, Nicolae Ochiana, Carlos Castellar-Otín
Format: Article
Language:English
Published: MDPI AG 2025-01-01
Series:Biology
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Online Access:https://www.mdpi.com/2079-7737/14/2/136
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author Alejandro García-Giménez
Francisco Pradas
Miguel Lecina
Nicolae Ochiana
Carlos Castellar-Otín
author_facet Alejandro García-Giménez
Francisco Pradas
Miguel Lecina
Nicolae Ochiana
Carlos Castellar-Otín
author_sort Alejandro García-Giménez
collection DOAJ
description Ultra-trail events (UTs) pose significant challenges to maintaining hydration and electrolyte balance, with risks of dehydration (DH), overhydration (OH), exercise-associated hyponatremia (EAH), and exertional rhabdomyolysis (ER). This study examined the effects of ad libitum (ADL) hydration on hydration status and muscle damage during a nine-stage UT (635 km, 40,586 m elevation gain). Four highly trained male athletes participated. Hydration was assessed via body weight loss (BWL), urine specific gravity (U<sub>sg</sub>), and serum sodium ([Na+]), while muscle damage markers included creatine kinase (CK), lactate dehydrogenase (LDH), and calcium (Ca), and liver damage biomarkers included aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Our results showed no cases of EAH or hypernatremia ([Na+] > 145 mmol·L<sup>−1</sup>), with serum [Na+] maintained above 135 mmol·L<sup>−1</sup>. BWL exceeded the 2% DH threshold in early stages (<i>p</i> = 0.029), and U<sub>sg</sub> remained elevated (>1.020 g·mL<sup>−1</sup>). LDH and CK significantly increased at all stages (<i>p</i> < 0.05), persisting for 48 h post-event. Correlations showed BWL aggravated muscle damage (r = 0.47 with CK) and hypocalcemia (r = −0.68 with Ca). Elevation gain/loss amplified fluid loss and muscle injury. While ADL hydration mitigated EAH, it did not fully address DH or muscle damage. Personalized hydration and recovery protocols are crucial to optimizing performance and health in UT events.
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spelling doaj-art-76fbb7d6591a49cea93c0fe4e0055dbd2025-08-20T02:44:52ZengMDPI AGBiology2079-77372025-01-0114213610.3390/biology14020136Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot StudyAlejandro García-Giménez0Francisco Pradas1Miguel Lecina2Nicolae Ochiana3Carlos Castellar-Otín4ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, SpainENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, SpainENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, SpainDepartment of Physical Education and Sports Performance, Faculty of Movement, Sports and Health Sciences, “Vasile Alecsandri” University of Bacau, 600115 Bacau, RomaniaENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, SpainUltra-trail events (UTs) pose significant challenges to maintaining hydration and electrolyte balance, with risks of dehydration (DH), overhydration (OH), exercise-associated hyponatremia (EAH), and exertional rhabdomyolysis (ER). This study examined the effects of ad libitum (ADL) hydration on hydration status and muscle damage during a nine-stage UT (635 km, 40,586 m elevation gain). Four highly trained male athletes participated. Hydration was assessed via body weight loss (BWL), urine specific gravity (U<sub>sg</sub>), and serum sodium ([Na+]), while muscle damage markers included creatine kinase (CK), lactate dehydrogenase (LDH), and calcium (Ca), and liver damage biomarkers included aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Our results showed no cases of EAH or hypernatremia ([Na+] > 145 mmol·L<sup>−1</sup>), with serum [Na+] maintained above 135 mmol·L<sup>−1</sup>. BWL exceeded the 2% DH threshold in early stages (<i>p</i> = 0.029), and U<sub>sg</sub> remained elevated (>1.020 g·mL<sup>−1</sup>). LDH and CK significantly increased at all stages (<i>p</i> < 0.05), persisting for 48 h post-event. Correlations showed BWL aggravated muscle damage (r = 0.47 with CK) and hypocalcemia (r = −0.68 with Ca). Elevation gain/loss amplified fluid loss and muscle injury. While ADL hydration mitigated EAH, it did not fully address DH or muscle damage. Personalized hydration and recovery protocols are crucial to optimizing performance and health in UT events.https://www.mdpi.com/2079-7737/14/2/136hyponatremiafluid imbalanceultra-endurancebody weight losshydration strategiesexertional rhabdomyolysis
spellingShingle Alejandro García-Giménez
Francisco Pradas
Miguel Lecina
Nicolae Ochiana
Carlos Castellar-Otín
Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
Biology
hyponatremia
fluid imbalance
ultra-endurance
body weight loss
hydration strategies
exertional rhabdomyolysis
title Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
title_full Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
title_fullStr Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
title_full_unstemmed Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
title_short Impact of Ad Libitum Hydration on Muscle and Liver Damage and Electrolyte Balance in Ultra-Trail Events: A Heatmap Analysis of Biomarkers and Event Characteristics—A Pilot Study
title_sort impact of ad libitum hydration on muscle and liver damage and electrolyte balance in ultra trail events a heatmap analysis of biomarkers and event characteristics a pilot study
topic hyponatremia
fluid imbalance
ultra-endurance
body weight loss
hydration strategies
exertional rhabdomyolysis
url https://www.mdpi.com/2079-7737/14/2/136
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