Introduction: Hyponatremia is one of the most common electrolyte disturbances in which drinking excessive hypotonic fluids during strenuous physical activity can lead to water poisoning and its associated health problems. Purpose: To determine the response and treatment of hyponatremia and hypotonic hyperhydration, to examine the roles of graduate nurses in prevention, detection, treatment and education at the primary and secondary stage of health care. Objective: To describe the causes that lead to these two electrolyte disturbances, to describe the content and role of treatment guidelines, to seek emergency medical activities at the prehospital and hospital care, to examine the knowledge and education of athletes and their coaches to prevent and respond to these conditions. Methods: We used a descriptive method based on a literature review. The search of the literature published between 2010–2020 was performed through the online digital library of the University of Ljubljana, on international online databases COBIB.SI, Medline/PubMed, CINAHL, ScienceDirect and Google Scholar. Keywords were: hyponatremia, hypotonic hyperhydration, intoxication with water, athletes. We used 42 units of literature. Results: Hyponatremia and water poisoning are life-threatening conditions that are common in professional and recreational endurance athletes due to improper hydration. Symptoms such as nausea, vomiting, confusion and cramps are unspecific, therefore, often overlooked. Emergency medical care at pre-hospital levels is aimed at rapid identification, transport and reduction of neurological consequences. As an expert, a nurse can be involved in comprehensive treatment and education. Several causes for inapropriate hydration planning are reported in the literature. The hydration plan must be individually adapted to suit individuals and conditions. Discussion and conclusion: An appropriate initial assessment of the condition and proper treatment is crucial to avoid complications. A qualified nurse must recognise the signs, symptoms and changes in blood parameters to provide quality standardized health care.
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