1
|
Pannone E, Abbott R. What is known about the health effects of non-steroidal anti-inflammatory drug (NSAID) use in marathon and ultraendurance running: a scoping review. BMJ Open Sport Exerc Med 2024; 10:e001846. [PMID: 38318269 PMCID: PMC10840051 DOI: 10.1136/bmjsem-2023-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
This systematic scoping review aimed to understand the extent and scope of evidence on the health risks of non-steroidal anti-inflammatory drug (NSAID) use in marathon and ultraendurance running. NSAIDs are commonly consumed by runners to combat pain and inflammation; however, the health risks of consuming these drugs during marathon and ultrarunning events are currently not fully understood. Four databases (Cochrane Library, PubMed, MEDLINE and SPORTDiscus) were searched to identify articles focusing on running events of 26.2 miles or further, and they must have reported on the health risks of NSAID use. There was no restriction on the study design or the date of publication. Thirty studies were ultimately included: 4 randomised controlled trials, 1 cross-sectional study, 11 retrospective reviews, 4 case reports, 1 non-randomised control trial, and 9 prospective observational studies. The literature showed that potential health concerns of NSAID use could be split into five categories: electrolyte balance and hyponatraemia; acute kidney injury (AKI); gastrointestinal disturbances; oxidative stress, inflammation and muscle damage; other medical concerns. None of these sections had clear statistically significant links with NSAID use in ultraendurance running. However, potential links were shown, especially in AKI and electrolyte balance. This review suggests there is very limited evidence to show that NSAIDs have a negative impact on the health of ultrarunning athletes. Indications from a few non-randomised studies of a possible effect on kidney function need exploring with more high-quality research.
Collapse
Affiliation(s)
- Eve Pannone
- Medical School, University of Exeter, Exeter, UK
| | - Rebecca Abbott
- Medical School, University of Exeter, Exeter, UK
- Evidence Synthesis Team, NIHR Applied Research Collaboration South West (PenARC), University of Exeter, Exeter, UK
| |
Collapse
|
2
|
Exercise-Associated Hyponatremia in Marathon Runners. J Clin Med 2022; 11:jcm11226775. [PMID: 36431252 PMCID: PMC9699060 DOI: 10.3390/jcm11226775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.
Collapse
|
3
|
Modesti PA, Casolo G, Olivotto I, Pellegrino A. Sudden death in young athletes: Is it preventable? Eur J Intern Med 2022; 104:13-20. [PMID: 35718646 DOI: 10.1016/j.ejim.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023]
Abstract
Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention. The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity. Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.
Collapse
Affiliation(s)
- Pietro Amedeo Modesti
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessio Pellegrino
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| |
Collapse
|
4
|
Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063651. [PMID: 35329337 PMCID: PMC8955583 DOI: 10.3390/ijerph19063651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
The majority of reviews on sports nutrition issues focus on macronutrients, often omitting or paying less attention to substances such as sodium. Through the literature, it is clear that there are no reviews that focus entirely on the effects of sodium and in particular on endurance sports. Sodium intake, both at high and low doses, has been found to be associated with health and performance issues in athletes. Besides, there have been theories that an electrolyte imbalance, specifically sodium, contributes to the development of muscle cramps (EAMC) and hyponatremia (EAH). For this reason, it is necessary to create this systematic review, in order to report extensively on the role of sodium consumption in the population and more specifically in endurance and ultra-endurance athletes, the relationship between the amount consumed and the occurrence of pathological disorders, the usefulness of simultaneous hydration and whether a disturbance of this substance leads to EAH and EAMC. As a method of data collection, this study focused on exploring literature from 2000–2021. The search was conducted through the research engines PubMed and Scopus. In order to reduce the health and performance effects in endurance athletes, simultaneous emphasis should be placed on both sodium and fluid intake.
Collapse
|
5
|
Breslow RG, Giberson-Chen CC, Roberts WO. Burden of Injury and Illness in the Road Race Medical Tent: A Narrative Review. Clin J Sport Med 2021; 31:e499-e505. [PMID: 32032158 DOI: 10.1097/jsm.0000000000000829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize the literature relating to prehospital care at 5 km through marathon distance road races and present the epidemiology of common medical encounters, significant medical complications, and medical outcomes. DATA SOURCES We searched PubMed and Google Scholar for the published literature pertaining to road race medical tent encounters at 5 km through marathon distance road races from 2000 to 2018. We included English-language, original articles reporting on injury and illness incidence. MAIN RESULTS Standard medical encounter definitions have recently been formulated in response to the previous lack of uniform definitions. The incidence of medical complications at road races may be influenced by environmental conditions and race distance. Minor and moderate medical encounters, such as dermatologic injuries, musculoskeletal injuries, and exercise-associated collapse, are common. Serious and life-threatening medical complications, including exertional heat stroke, exercise-associated hyponatremia, and cardiac arrest, are less frequent. Fatalities are also rare, with rates of 0.3 to 5 per 100 000 participants reported at marathons. The ratio of hospital transports to medical encounters is low. CONCLUSIONS On-site medical services play a key role in the safety of both runners and the community. Future research and care initiatives in this field should focus on optimizing treatment protocols, promoting injury prevention efforts and reducing host community costs.
Collapse
Affiliation(s)
- Rebecca G Breslow
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- International Institute for Race Medicine, Plymouth, Massachusetts
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and
- International Institute for Race Medicine, Plymouth, Massachusetts
| |
Collapse
|
6
|
Breslow RG, Collins JE, Troyanos C, Cohen MC, D'Hemecourt P, Dyer KS, Baggish A. Exertional Heat Stroke at the Boston Marathon: Demographics and the Environment. Med Sci Sports Exerc 2021; 53:1818-1825. [PMID: 33756522 DOI: 10.1249/mss.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to assess associations between exertional heat stroke (EHS) and sex, age, prior performance, and environmental conditions, and report on resources needed for EHS cases at the Boston Marathon. METHODS We analyzed participant characteristics, environmental data, and EHS medical encounters during the 2015-2019 Boston Marathon races. RESULTS Among 136,161 starters, there was an incidence of 3.7 EHS cases per 10,000 starters (95% confidence interval, 2.8-4.9), representing 0.5% of all medical encounters. There were significant associations between sex and age (P < 0.0001), sex and start wave (P < 0.0001), and age group and start wave (P < 0.0001). Sex was not significantly associated with increased EHS incidence; however, age younger than 30 yr and assignment to the first two start waves were. All cases occurred at races with average wet bulb globe temperatures of 17°C-20°C. There was a linear correlation between EHS incidence and greater increases in wet bulb globe temperature from start to peak (R2 = 0.7688). A majority of cases (37; 72.5%) were race finishers; nonfinishers all presented after mile 18. Most were triaged 3-4 h after starting, and all were treated with ice water immersion. Treatment times were prolonged (mean (SD), 78.1 (47.5) min; range, 15-190 min); 29.4% (15 cases) developed posttreatment hypothermia, and 35.3% (18 cases) were given intravenous fluids. Most (31 cases; 64.6%) were discharged directly, although 16 cases (33.3%) required hospital transport. There were no fatalities. CONCLUSIONS Younger and faster runners are at higher risk for EHS at the Boston Marathon. Greater increases in heat stress from start to peak during a marathon may exacerbate risk. EHS encounters comprise a small percentage of race-day medical encounters but require extensive resources and warrant risk mitigation efforts.
Collapse
Affiliation(s)
| | | | | | | | | | - K Sophia Dyer
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
| | | |
Collapse
|
7
|
Exercise-Associated Hyponatremia during the Olympus Marathon Ultra-Endurance Trail Run. Nutrients 2020; 12:nu12040997. [PMID: 32260197 PMCID: PMC7230381 DOI: 10.3390/nu12040997] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Research on hyponatremia during mountain marathons is scarce. The present study aimed to investigate the prevalence of exercise-associated hyponatremia during a 44-km trail running race that reached an altitude of 2780 m (Olympus Marathon). Sixty-two runners (five women) who completed the race participated in the study (age: 34.4 ± 8.6 years; height: 1.77 ± 0.06 m; and weight: 75.3 ± 10.0 kg). Anthropometric characteristics, blood, and urine samples were collected pre- and post-race. Food and fluid intake were recorded at each checkpoint. Due to race regulations, the runners could not carry any additional food and fluids besides the ones provided at specific checkpoints. Five runners (8%) exhibited asymptomatic hyponatremia (serum sodium <135 mmol∙L-1). Serum sodium in the hyponatremic runners decreased from 138.4 ± 0.9 (pre) to 131.4 ± 5.0 mmol∙L-1 (post), p < 0.05. Plasma osmolality increased only in the eunatremic runners (pre: 290 ± 3; post: 295 ± 6 mmol∙kg-1; p < 0.05). Plasma volume decreased more in the hyponatremic compared to eunatremic runners (-4.4 ± 2.0 vs. -3.2 ± 1.4%, p < 0.05). Lastly, dietary sodium intake was lower in the hyponatremic runners compared to eunatremic (789 ± 813 vs. 906 ± 672 mg; p < 0.05). The incidence of hyponatremia among the athletes was relatively low, possibly due to race conditions.
Collapse
|
8
|
Hoppel F, Calabria E, Pesta D, Kantner-Rumplmair W, Gnaiger E, Burtscher M. Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners. Front Physiol 2019; 10:1300. [PMID: 31749706 PMCID: PMC6843057 DOI: 10.3389/fphys.2019.01300] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022] Open
Abstract
Ultramarathon running represents a major physical challenge even for elite athletes. Runners wellbeing may be challenged by fluid and electrolyte disturbances, hemolysis and skeletal muscle damage, decline in hepatic function and kidney injury. We hypothesized that these effects may even be exacerbated in non-elite runners. Physiological, hematological and biochemical parameters of ten males (26–45 years, weekly training time 8.5 h), participating in a mountain ultramarathon (67 km; approximately 4,500 m of total ascent), were determined before (PRE), immediately after finishing the ultramarathon (POST), and 24 h after the individual finish (REC). Race times of the 8 finishers (2 drop-outs due to hot ambient temperature) varied between 10.4 and 16.1 h, which almost represents the range of the entire starter field (8.82 h–17.47 h). The following changes in mean values of selected markers for skeletal muscle damage and kidney injury were observed from PRE to POST: creatine kinase (CK) + 1289%, lactate dehydrogenase (LDH) + 87%, serum creatinine (CR) + 72%, blood urea nitrogen (BUN) + 96%, and estimated glomerular filtration rate (eGFR) – 45%. Values of CK + 1447%, LDH + 56%, and BUN + 71% remained elevated at REC. White blood cells were increased (+ 137%) only POST. In conclusion, CK and LDH levels and leucocytosis may be considered to be relatively harmless “side-effects” of prolonged running in this group of male subjects with rather moderate ultramarathon experience and training status. However, acute kidney injury may become clinically relevant in this population under the certain conditions, which should be considered by responsible race managers and medical advisors.
Collapse
Affiliation(s)
- Florian Hoppel
- Oroboros Instruments, Innsbruck, Austria.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Elisa Calabria
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dominik Pesta
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Wilhelm Kantner-Rumplmair
- Psychosomatic Pain Ambulance, University Hospital for Medical Psychology and Psychotherapy, Innsbruck, Austria
| | - Erich Gnaiger
- Oroboros Instruments, Innsbruck, Austria.,D. Swarovski Research Laboratory, Department of Visceral, Transplant Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Knechtle B, Chlíbková D, Papadopoulou S, Mantzorou M, Rosemann T, Nikolaidis PT. Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E537. [PMID: 31455034 PMCID: PMC6780610 DOI: 10.3390/medicina55090537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 12/05/2022]
Abstract
Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).
Collapse
Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, 61669 Brno, Czech Republic
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
| | - Maria Mantzorou
- Food Science and Nutrition Department, University of the Aegean, 81400 Myrina, Greece
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
| |
Collapse
|
10
|
Knechtle B, Chlíbková D, Nikolaidis PT. [Exercise-Associated Hyponatremia in Endurance Performance]. PRAXIS 2019; 108:615-632. [PMID: 31288661 DOI: 10.1024/1661-8157/a003261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.
Collapse
Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen Am Vadianplatz, St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich, Zürich
| | - Daniela Chlíbková
- 3 Centre of Sports Activities, Brno University of Technology, Brno, Tschechien
| | | |
Collapse
|
11
|
McDermott BP, Anderson SA, Armstrong LE, Casa DJ, Cheuvront SN, Cooper L, Kenney WL, O'Connor FG, Roberts WO. National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active. J Athl Train 2017; 52:877-895. [PMID: 28985128 PMCID: PMC5634236 DOI: 10.4085/1062-6050-52.9.02] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals. BACKGROUND Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals. RECOMMENDATIONS Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.
Collapse
|
12
|
Emerson DM, Torres-McGehee TM, Davis JM, Chen SC, Durstine JL, Pfeifer CE, Emerson CC, Stone JV, Bivona JD. Effects of a 24-h naproxen dose on hydration and electrolyte measures during moderate-intensity cycling in the heat. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Few controlled laboratory studies have examined the negative effects non-steroidal anti-inflammatory drugs can have on fluid–electrolyte balance during exercise. Our objective was to determine whether a 24-h naproxen dose negatively affected hydration and electrolyte measures before, during, and 3 h after 90 min of cycling in a hot or ambient environment. Using a double blind, randomized and counterbalanced cross-over design, 11 volunteers (six male, five female) completed four trials, with conditions as follows: (1) placebo and ambient, (2) placebo and heat, (3) naproxen and ambient, and (4) naproxen and heat. We found no statistically significant differences among experimental conditions for any dependent measures. Though not statistically significant, mean fluid volume was higher and urine volume was lower during naproxen trials compared with placebos. Mean aggregate plasma sodium was <135 mmol/L at all time points and did not significantly change over time. Overall plasma potassium significantly increased pre- (3.9 ± 0.4) to post-exercise (4.2 ± 0.4 mmol/L, p = 0.02). In conclusion, an acute naproxen dose did not significantly alter hydration–electrolyte balance. The trend for naproxen to increase fluid volume and decrease urine volume suggests the start of fluid retention, which should concern individuals at risk for hyponatremia or with pre-existing cardiovascular conditions.
Collapse
Affiliation(s)
- Dawn M. Emerson
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Toni M. Torres-McGehee
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - J. Mark Davis
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Stephen C.L. Chen
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - J. Larry Durstine
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Craig E. Pfeifer
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Charles C. Emerson
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Justin V. Stone
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Joseph D. Bivona
- Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| |
Collapse
|
13
|
Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-Associated Hyponatremia: 2017 Update. Front Med (Lausanne) 2017; 4:21. [PMID: 28316971 PMCID: PMC5334560 DOI: 10.3389/fmed.2017.00021] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/16/2017] [Indexed: 12/21/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was initially described in the 1980s in endurance athletes, and work done since then has conclusively identified that overdrinking beyond thirst and non-osmotic arginine vasopressin release are the most common etiologic factors. In recent years, EAH has been described in a broader variety of athletic events and also has been linked to the development of rhabdomyolysis. The potential role of volume and sodium depletion in a subset of athletes has also been described. This review focuses on the most recent literature in the field of EAH and summarizes key new findings in the epidemiology, pathophysiology, treatment, and prevention of this condition.
Collapse
Affiliation(s)
| | - Valentina Loi
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Antonello Pani
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System , Charlottesville, VA , USA
| |
Collapse
|
14
|
Abstract
AbstractExertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.PryorRR,RothRN,SuyamaJ,HostlerD.Exertional heat illness: emerging concepts and advances in prehospital care.Prehosp Disaster Med.2015;30(3):19.
Collapse
|
15
|
Traiperm N, Gatterer H, Burtscher M. Plasma electrolyte and hematological changes after marathon running in adolescents. Med Sci Sports Exerc 2014; 45:1182-7. [PMID: 23274613 DOI: 10.1249/mss.0b013e3182831a93] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE The objective of this research is to study plasma electrolyte and hematological changes in adolescent runners completing a standard 42.2-km marathon run. METHODS Fifty adolescents (30 healthy males and 20 healthy females) between ages 13 and 17 yr participated in the study. The participants had to undergo a routine physical examination including ECG records. Blood was taken before the race, immediately after the race, and 24 h after the race to determine complete blood cell count and electrolyte concentration. RESULTS Forty-seven runners completed the race with a mean finishing time of 4 h 57 min (range: 3 h 17 min 09 s to 6 h 14 min). None of the participants experienced an adverse medical event during or after the race. Only slight changes in plasma electrolytes without any cases of hyper- or hyponatremia and a marked increase in white blood cell count were demonstrated immediately after the race. At this time, the hemoglobin concentration and hematocrit were decreased (P < 0.05), indicating an approximately 11% increase in plasma volume. Some of these changes were still present 24 h postrace. No differences were observed between sexes. CONCLUSIONS This is the first study evaluating plasma electrolyte and hematological changes in a relatively large sample of young runners completing a standard marathon. The presented findings indicate that well-trained and educated adolescent marathon runners are not at risk to develop clinically significant electrolyte or hematological changes.
Collapse
Affiliation(s)
- Natthapon Traiperm
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | | | | |
Collapse
|
16
|
Mohseni M, Silvers S, McNeil R, Diehl N, Vadeboncoeur T, Taylor W, Shapiro S, Roth J, Mahoney S. Prevalence of hyponatremia, renal dysfunction, and other electrolyte abnormalities among runners before and after completing a marathon or half marathon. Sports Health 2012; 3:145-51. [PMID: 23016001 PMCID: PMC3445140 DOI: 10.1177/1941738111400561] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Prior reports on metabolic derangements observed in distance running frequently have small sample sizes, lack prerace laboratory measures, and report sodium as the sole measure. Hypothesis: Metabolic abnormalities—hyponatremia, hypokalemia, renal dysfunction, hemoconcentration—are frequent after completing a full or half marathon. Clinically significant changes occur in these laboratory values after race completion. Study Design: Observational, cross-sectional study. Methods: Consenting marathon and half marathon racers completed a survey as well as finger stick blood sampling on race day of the National Marathon to Fight Breast Cancer (Jacksonville, Florida, February 2008). Parallel blood measures were obtained before and after race completion (prerace, n = 161; postrace, n = 195). Results: The prevalence of prerace and postrace hyponatremia was 8 of 161 (5.0%) and 16 of 195 (8.2%), respectively. Hypokalemia was not present prerace but was present in 1 runner postrace (1 of 195). Renal dysfunction occurred prerace in 14 of 161 (8.7%) and postrace in 83 of 195 (42.6%). Among those with postrace renal dysfunction, 45.8% (38 of 83) were classified as moderate or severe. Hemoconcentration was present in 2 of 161 (1.2%) prerace and 6 of 195 (3.1%) postrace. The mean changes in laboratory values were (postrace minus prerace): sodium, 1.6 mmol/L; potassium, −0.2 mmol/L; blood urea nitrogen, 2.8 mg/dL; creatinine, 0.2 mg/dL; and hemoglobin, 0.3 g/dL for 149 pairs (except blood urea nitrogen, n = 147 pairs). Changes were significant for all comparisons (P < 0.01) except potassium (P = 0.08) and hemoglobin (P = 0.01). Conclusions: Metabolic abnormalities are common among endurance racers, and they may be present prerace, including hyponatremia. The clinical significance of these findings is unknown. Clinical relevance: It is unclear which runners are at risk for developing clinically important metabolic derangements. Participating in prolonged endurance exercise appears to be safe in the majority of racers.
Collapse
|
17
|
Can changes in body mass and total body water accurately predict hyponatremia after a 161-km running race? Clin J Sport Med 2010; 20:193-9. [PMID: 20445360 DOI: 10.1097/jsm.0b013e3181da53ea] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To relate changes in body mass, total body water (TBW), extracellular fluid (ECF), and serum sodium concentration ([Na]) from a 161-km ultramarathon to finish time and incidence of hyponatremia. DESIGN Observational. SETTING : The 2008 Rio Del Lago 100-Mile (161-km) Endurance Run in Granite Bay, California. PARTICIPANTS Forty-five runners. MAIN OUTCOME MEASUREMENTS Pre-race and post-race body mass, TBW, ECF, and serum [Na]. RESULTS Body mass and serum [Na] significantly decreased 2% to 3% (P < 0.001) from pre-race to post-race, but TBW and ECF were unchanged. Significant relationships were observed between finish time and percentage change in body mass (r = 0.36; P = 0.01), TBW (r = 0.50; P = 0.007), and ECF (r = 0.61; P = 0.003). No associations were found between post-race serum [Na] and percentage change in body mass (r = -0.04; P = 0.94) or finish time (r = 0.5; P = 0.77). Hyponatremia (serum [Na] < 135 mmol/L) was present among 51.2% of finishers. Logistic regression prediction equation including pre-race TBW and percentage changes in TBW and ECF had an 87.5% concordance with the classification of hyponatremia. CONCLUSIONS Hyponatremia occurred in over half of the 161-km ultramarathon finishers but was not predicted by change in body mass. The combination of pre-race TBW and percentage changes in TBW and ECF explained 87.5% of the variation in the incidence of hyponatremia. CLINICAL SIGNIFICANCE Exercise-associated hyponatremia can occur simultaneously with dehydration and cannot be predicted by weight checks at races.
Collapse
|
18
|
|
19
|
Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference, New Zealand, 2007. Clin J Sport Med 2008; 18:111-21. [PMID: 18332684 DOI: 10.1097/jsm.0b013e318168ff31] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
20
|
Abstract
OBJECTIVE Describe risk factors for lower post-race [Na+] and exercise-associated hyponatremia (EAH) (serum [Na+]<135 mmol/L) during marathon running. DESIGN Prospective observational study. SETTING Houston Marathon 2000-2004. PATIENTS Ninety-six runners from EAH research projects. INTERVENTIONS Observational. MAIN OUTCOME MEASUREMENTS Pre-race and post-race measurements: serum [Na+], weight, and fluid ingestion. RESULTS Twenty-one runners (22%) met criteria for EAH, and 87% of subjects had lower post-race [Na+] compared to pre-race [Na+]. Lower post-race [Na+] and larger [Na+] decrease were related to lower pre-race [Na+], less weight loss during the race, and more fluid cups consumed. Increased fluid consumed correlated with slower finish time, male gender, and warmer temperature. Less weight loss correlated with lower pre-race weight, more fluid consumed, and slower finish time. Losing less than 0.75 kg increased the risk of becoming hyponatremic 7 fold (RR=7.0; CI 1.8 to 26.6) compared to those who lost more than 0.75 kg. Women consumed fluid at a significantly lower rate than men (P=0.04). Estimated mean fluid balance for women was positive and significantly higher than men's negative fluid balance (P<0.0001). Fluid balance became more positive as finish time increased and pre-race weight decreased. CONCLUSIONS Lighter and slower runners have more positive fluid balance. Losing>0.75 kg of body weight during a marathon is advisable in order to decrease the risk of EAH. Runners should measure their sweat rate and monitor weight changes as part of their fluid consumption plan.
Collapse
|
21
|
Reid SA, King MJ. Serum biochemistry and morbidity among runners presenting for medical care after an Australian mountain ultramarathon. Clin J Sport Med 2007; 17:307-10. [PMID: 17620786 DOI: 10.1097/jsm.0b013e31804c77da] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if exercise-associated hyponatremia (EAH) was a cause of morbidity among runners requiring medical care at an Australian mountain ultramarathon. DESIGN Case series. SETTING Six Foot Track mountain ultramarathon, New South Wales, Australia, March 2006. PATIENTS Runners presenting to the medical facility. ASSESSMENT Serum biochemistry. RESULTS No cases of exercise-associated hyponatremia were identified among 9 athletes (from 775 starters) who were treated with intravenous fluid therapy. Unwell runners had a mean serum (Na) of 143 mmol/L (range 138-147 mmol/L). All runners tested had elevated serum urea and creatinine concentrations. CONCLUSION In this setting, EAH was not a significant cause of morbidity.
Collapse
|
22
|
Page AJ, Reid SA, Speedy DB, Mulligan GP, Thompson J. Exercise-associated hyponatremia, renal function, and nonsteroidal antiinflammatory drug use in an ultraendurance mountain run. Clin J Sport Med 2007; 17:43-8. [PMID: 17304005 DOI: 10.1097/jsm.0b013e31802b5be9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study biochemical parameters and renal function in runners completing a 60 km mountain run and to investigate the incidence of exercise-associated hyponatremia (EAH). To assess the effects of nonselective nonsteroidal antiinflammatory medication (NSAIDs) and cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory medication (COXIBs) on these parameters. DESIGN Observational cohort study. SETTING Kepler Challenge 60 km mountain run, Te Anau, New Zealand, December 2003. PARTICIPANTS One hundred thirty-one of the 360 runners entered in the race were prospectively enrolled as volunteers on the day before the race. MAIN OUTCOME MEASURES Subjects were weighed at race registration the day before the race and at the finish line. Blood was taken within 5 minutes of finishing and was analyzed for serum sodium, creatinine, urea, and potassium concentrations, and hematocrit. Participants were questioned about medication use in the 24 hours before and during the race (NSAIDs, COXIBs, other medications). RESULTS Complete data sets were obtained on 123 runners. Five athletes were biochemically hyponatremic [(Na) 130-134 mM] and four were hypernatremic [(Na) 146-148 mM]. Hyponatremia was associated with a mean weight gain of 1.32 kg (range, -1.5 to 1.6 kg). Serum [Na] varied inversely with weight change. Estimated creatinine clearance did not vary with percent weight loss. Estimated creatinine clearance declined with increasing runner age. Sixty-five percent of runners did not use any medication, whereas 20% had used NSAIDs and 15% had taken COXIBs. There were no statistically significant differences between NSAID and COXIB users in any measured parameters or between all NSAID and COXIB users when compared with nonusers. CONCLUSIONS Mild asymptomatic EAH was found to occur in 4% of the volunteer ultraendurance mountain runner study group and was associated with a mean weight gain of 1.32 kg (range, -1.5 to 1.6 kg) during the race. Seven percent gained weight but remained normonatremic, suggesting other compensatory mechanisms. Hypernatremia was found in 3% and was associated with a mean weight loss. Postrace serum sodium concentration varied inversely with percent weight change. Runners using any NSAID were more likely to become hyponatremic. Estimated creatinine clearance increased with increasing age. Elevated serum creatinine concentration at the end of the race returned to normal when remeasured the week after the race. Thirty-five percent of runners were found to use NSAIDs or COXIBs. The measures of weight change and of serum sodium, potassium, urea, and creatine concentration did not differ between NSAID and COXIB users or between all nonsteroidal antiinflammatory users and nonusers.
Collapse
Affiliation(s)
- A J Page
- SportsMed Canterbury, 194 Dyers Pass Road, Cashmere, Christchurch, New Zealand.
| | | | | | | | | |
Collapse
|
23
|
Abstract
Exercise-associated hyponatremia has been described after sustained physical exertion during marathons, triathlons, and other endurance athletic events. As these events have become more popular, the incidence of serious hyponatremia has increased and associated fatalities have occurred. The pathogenesis of this condition remains incompletely understood but largely depends on excessive water intake. Furthermore, hormonal (especially abnormalities in arginine vasopressin secretion) and renal abnormalities in water handling that predispose individuals to the development of severe, life-threatening hyponatremia may be present. This review focuses on the epidemiology, pathogenesis, and therapy of exercise-associated hyponatremia.
Collapse
Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
| | | |
Collapse
|
24
|
Abstract
This article examines environmental illness in athletes. Causes, symptoms, and treatment of heat-related illness, cold-related illness, and altitude-related illness are discussed.
Collapse
Affiliation(s)
- Craig K Seto
- Department of Family Medicine, University of Virginia Health System, PO Box 800729, Charlottesville, VA 22908, USA.
| | | | | |
Collapse
|
25
|
Hew-Butler T, Almond C, Ayus JC, Dugas J, Meeuwisse W, Noakes T, Reid S, Siegel A, Speedy D, Stuempfle K, Verbalis J, Weschler L. Consensus statement of the 1st International Exercise-Associated Hyponatremia Consensus Development Conference, Cape Town, South Africa 2005. Clin J Sport Med 2005; 15:208-13. [PMID: 16003032 DOI: 10.1097/01.jsm.0000174702.23983.41] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Tamara Hew-Butler
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Department of Human Biology, University of Cape Town, Newlands, South Africa.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
One must remember that the first marathon runner, Phidippides, collapsed and died at the finish of his race. Fortunately, death has been an infrequent occurrence in modern day marathons. However, the physical exertion required to complete a marathon coupled with exposure to often harsh environmental conditions and an increase in the number of novice participants makes injuries inevitable. The medical team's main goal is to implement strategies to prevent serious injury and illness through pre-event planning, race day preparedness, and postevent evaluations. The three general categories of injuries encountered with marathon participation include medical conditions, musculoskeletal injuries, and dermatologic complaints. The focus of this article is on the evaluation and management of the varied medical concerns encountered on race day along with the essentials in prerace planning and preparedness.
Collapse
Affiliation(s)
- Carrie A Jaworski
- Resurrection Family Practice Residency, 7447 West Talcott, Suite #182, Chicago, IL 60631, USA.
| |
Collapse
|
27
|
Baker J, Cotter JD, Gerrard DF, Bell ML, Walker RJ. Effects of Indomethacin and Celecoxib on Renal Function in Athletes. Med Sci Sports Exerc 2005; 37:712-7. [PMID: 15870622 DOI: 10.1249/01.mss.0000162700.66214.ce] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Strenuous exercise induces a marked reduction in renal hemodynamics. Prostaglandins (PG) play an important role in maintaining renal integrity in the face of hemodynamic changes. Inhibition of cyclooxygenase (COX) and thus PG formation can further compromise renal perfusion. The role of selective COX-2 inhibition on renal hemodynamics during exercise has not been investigated. METHODS Twelve healthy males (22-47 yr) took part in a randomized placebo controlled study investigating the effects of nonselective COX inhibition (indomethacin) and COX-2 selective inhibition (celecoxib) on renal hemodynamics during exercise. Renal blood flow (RBF), glomerular filtration rate (GFR), and free water clearance were measured using standard clearance techniques. Each experimental session was performed at least a week apart. The medications were taken for 36 h before study with the last dose at 0700 h on the day of study. Following baseline studies, each participant exercised for 30 min at 80% of their maximal aerobic power. Renal function was monitored for 2 h post-recovery. RESULTS RBF and GFR fell by 40% after exercise with no significant difference between placebo, indomethacin, or celecoxib. Indomethacin (-2.43 +/- 0.95 mL x min(-1), P < 0.007) and celecoxib (-3.88 +/- 0.94 mL x min(-1), P < 0.0001) significantly reduced free water clearance compared with placebo during recovery. CONCLUSION This study has confirmed that selective and nonselective COX inhibition can induce significant inhibition of free water clearance, indicating that these acute changes are regulated predominantly via COX-2. Acute cerebral edema with hyponatremia has been reported after major endurance sporting events. Identifiable risk factors include excessive hydration and use of NSAID. Impaired free water clearance during exercise potentiated by COX inhibition provides a pathophysiological explanation for these observations.
Collapse
Affiliation(s)
- Jordan Baker
- Department of Medical & Surgical Sciences, Dunedin School of Medicine, University of Otago Dunedin, New Zealand
| | | | | | | | | |
Collapse
|
28
|
Kratz A, Siegel AJ, Verbalis JG, Adner MM, Shirey T, Lee-Lewandrowski E, Lewandrowski KB. Sodium Status of Collapsed Marathon Runners. Arch Pathol Lab Med 2005; 129:227-30. [PMID: 15679427 DOI: 10.5858/2005-129-227-ssocmr] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
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.
Collapse
Affiliation(s)
- Alexander Kratz
- Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
This review focuses on possible pathophysiology of exercise-associated hyponatraemia and its implication on evaluation and treatment of collapsed athletes during endurance events. Rehydration guidelines and field care have traditionally been based on the belief that endurance events create a state of significant fluid deficit in athletes, which must be corrected by liberal hydration. Beliefs in the necessity of liberal hydration may have contributed to cases of hyponatraemia. Assumptions that fluid loss accounts for the entire weight loss during exercise and that fluid ingestion is the only source of water gain during exercise may lead to an overestimation of the degree of volume depletion and the amount of fluid needed for replacement. Increasing evidence suggests that hyponatraemic athletes are fluid overloaded; ingestion of large amount of hypotonic fluid in combination with inappropriate or inadequate physiological responses leads to excessive retention of free fluid. Risk factors include hot weather, female sex, slower finishing time, and possibly the use of nonsteroidal anti-inflammatory medications. Symptoms of hyponatraemia can be subtle and can mimic those of other exercise-related illnesses, thereby complicating its diagnosis and leading to possible inappropriate treatment. Most athletes who collapse at the finish line experience exercise-associated collapse, a benign and transient form of postural hypotension that can be treated simply by continued ambulation after finishing or elevation of legs while in a supine position for those who cannot walk. Care providers should consider the use of intravenous hydration with normal saline carefully since it is not needed by most collapsed athletes and may worsen the condition of patients with unsuspected hyponatraemia. Historic information and clinical signs of volume depletion should be elicited prior to its use. Most hyponatraemic athletes will recover uneventfully with careful observation while awaiting spontaneous diuresis. Use of hypertonic saline should be reserved for patients with severe symptoms. Moderate consumption of carbohydrate-electrolyte solution during exercise may allow the maintenance of adequate hydration and the prevention of hyponatraemia.
Collapse
Affiliation(s)
- Margaret Hsieh
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
30
|
Chou LH, Akuthota V, Drake DF, Toledo SD, Nadler SF. Sports and performing arts medicine. 3. Lower-limb injuries in endurance sports. Arch Phys Med Rehabil 2004; 85:S59-66. [PMID: 15034857 DOI: 10.1053/j.apmr.2003.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed learning module highlights new advances in this topic area. It is part of the study guide on sports medicine and performing arts in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on (1) ankle pain in a runner, (2) heel pain in an adolescent, (3) anterior knee pain in a runner, (4) lateral knee pain in a cyclist, (5) shin splints in a runner, (6) buttock pain in a hiker, and (7) collapse of a marathoner from hyponatremia. OVERALL ARTICLE OBJECTIVE To summarize lower-limb injuries commonly seen in endurance sports.
Collapse
Affiliation(s)
- Larry H Chou
- Department of Rehabilitation, University of Pennsylvania, Philadelphia, USA.
| | | | | | | | | |
Collapse
|