Exertional hyponatremia among U.S. active component service members, 2021-2025.

Abstract

Exertional hyponatremia, also known as exercise-associated hyponatremia, is a fluid electrolyte disorder defined by a low sodium level in the blood (below 135 mEq/L). Exertional hyponatremia results from excessive fluid intake that dilutes serum sodium, impairing neurological and other organ functions. Hyponatremia can be fatal if not detected early and managed properly. From 2021 through 2025, 609 cases of exertional hyponatremia were diagnosed among U.S. active component service members (ACSMs), with an overall incidence rate of 9.2 cases per 100,000 person-years (p-yrs). In 2025, 106 cases of exertional hyponatremia were diagnosed among ACSMs, resulting in an incidence rate of 8.1 per 100,000 p-yrs. The highest incidence rates in 2025 were observed among males, individuals ages 35-39 years, non-Hispanic White service members, those in health care occupations, and personnel stationed in the western U.S. Notably, between 2024 and 2025 the Marine Corps and recruit populations showed a sharp decline in cases. From 2021 to 2023, annual rates of incident exertional hyponatremia diagnoses increased, peaking in 2023 (11.6 per 100,000 p-yrs) and then decreased to 8.1 cases per 100,000 p-yrs in 2025. Although the incidence of exertional hyponatremia is decreasing, continued monitoring and specialized prevention strategies are critical, as the associated risk factors may affect individuals differently. Incidence rates of exertional hyponatremia decreased from 10.6 per 100,000 people per year in 2024 to 8.1 per 100,000 in 2025. Rates increased sharply in the 35-39-years age group, however, while decreasing sharply among those younger than age 20 years, ages 25-29 years, and in the Marine Corps.