When an athlete consumes more fluids than necessary, and/or sodium lost in sweat is not adequately replaced, sodium in the bloodstream becomes diluted and can cause cerebral and/or pulmonary edema.

  • Recognition: Possible symptoms include increasing headache, nausea, vomiting (often repetitive), swelling of extremities, irregular diet with inadequate sodium intake, copious urine with low specific gravity following exercise, lethargy/apathy, and agitation. If the condition progresses, CNS changes (altered consciousness, confusion, coma, convulsions, altered cognitive functioning).
  • Treatment: Preventative methods to maintain proper sodium levels. Sodium intake via electrolyte drinks or other sources. If blood sodium levels cannot be determined onsite, hold off on rehydration and transport athlete to a medical facility.
  • Return to play Considerations: Physician clearance is strongly recommended in all cases. In mild cases, activity can resume a few days after completing and educational session on establishing and individual-specific hydration protocol.


J.D. Boudreaux, PT, SCS, LAT, ATC

McLeod-Trahan-Sheffield Physical Therapy Services, LLC