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Authors A Kratz, AJ Siegel, JG Verbalis, MM Adner, T Shirey, E LeeLewandrowski, 
KB Lewandrowski
Title   Sodium status of collapsed marathon runners
Full source     Archives of Pathology & Laboratory Medicine, 2005, Vol 129, Iss 
2, pp 227-230

Context.-Recommendations for prevention and treatment of medical emergencies in 
participants in marathon races center on maintenance of adequate hydration 
status and administration of fluids. Recently, new recommendations for fluid 
replacement for marathon runners were promulgated by medical and athletic 
societies. These new guidelines encourage runners to drink ad libitum between 
400 and 800 mL/h as opposed to the previous ''as much as possible'' advice. 
Objective.-To assess the sodium and hydration (plasma osmolality) status of 
collapsed marathon runners after the promulgation of new hydration guidelines. 
Design.-Plasma sodium and osmolality values of runners who presented to the 
medical tent at the finish line of the 2003 Boston Marathon were measured. 
Results.-Using reference ranges derived from the general population, of 140 
collapsed runners, 35 (25%) were hypernatremic (sodium, >146 mEq/L) and 6 (12%) 
were hyperosmolar (osmolality, >296 mOsm/kg H2O), whereas 9 (6%) were 
hyponatremic (sodium, <135 mEq/L) and 8 (16%) were hypo-osmolar (osmolality, 
<280 mOsm/kg H2O). Compared with a population of marathon runners who had 
experienced no medical difficulties, 9% of the runners were hypernatremic, 5% 
were hyponatremic, 8% were hypo-osmolar, and none were hyperosmolar. 
Conclusions.-Our findings indicate a significant incidence of hypernatremia 
with hyperosmolality and hyponatremia with hypo-osmolality among collapsed 
runners despite the new fluid intake recommendations, suggesting that either 
further educational measures are required or that the new guidelines are not 
entirely adequate to prevent abnormalities in fluid balance. Furthermore, the 
immediate medical management of hypernatremia and hyponatremia is different. 
Administration of fluids to severely hyponatremic patients may result in fatal 
cerebral edema. Our findings caution against institution of treatment until 
laboratory tests determine the patient's sodium status.


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