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This work combines and reanalyzes 5 yr of exercise-associated hyponatremia (EAH) research at 161-km ultramarathons in northern California with primary purposes to define the relationship between postrace blood sodium concentration ([Na+]) and change in body weight; to examine the interactions among EAH incidence, ambient temperature, and hydration state; and to explore the effect of hydration status on performance.Prerace and postrace body weight and finish time data were obtained on 887 finishers, and postrace [Na+] was also obtained on a subset of 669 finishers.EAH incidence was 15.1% overall (range, 4.6%–51.0% by year) and had a significant positive relationship with ambient temperature. Of the runners with EAH, 23.8% were classified as overhydrated (weight change, ≥0), 40.6% were euhydrated (weight change, <0% to –3%), and 35.6% were dehydrated (weight change, <–3%) at the finish. There was a weak significant relationship (r = 0.17, P < 0.0001) between postrace [Na+] and change in body weight such that a lower [Na+] was more common with increased weight loss. Considering all finishers examined, 18.5% were dehydrated and 34.9% were overhydrated at the finish. There was a weak significant relationship (r = 0.092, P = 0.006) between change in body weight and performance in that faster runners tended to lose more weight. Top finishers varied in body weight change from ∼1% gain to ∼6% loss.EAH incidence can be high in 161-km ultramarathons in northern California. In this environment, EAH is more common with dehydration than overhydration and is more common in hotter ambient temperature conditions. Because weight loss >3% does not seem to have an adverse effect on performance, excessive sodium supplementation and aggressive fluid ingestion beyond the dictates of thirst are ill advised.