Dysnatremia may cause life-threatening encephalopathy in marathon runners. Hypernatremia and exercise-associated hyponatremia (EAH) may manifest with mental status changes and, if untreated, progress to coma and death. We reviewed the on-site blood sodium testing and treatment in collapsed runners at the finish-line medical tent at the Boston marathons from 2001 through 2008. Dysnatremia was diagnosed in 429 (32.5%) of 1,319 collapsed runners. Hypernatremia was present in 366 (27.7%) and hyponatremia in 63 (4.8%). Hypernatremic runners unable to drink fluids were treated with intravenous normal (0.9%) saline. Hyponatremic runners with seizures or coma received intravenous hypertonic (3%) saline. Sixteen runners with EAH able to drink a concentrated oral hypertonic solution recovered within 30 minutes. Based on on-site sodium testing, dysnatremic runners were treated with appropriate intravenous fluids according to validated standards of care. Hyponatremic runners able to drink an oral hypertonic solution recovered promptly.
In brief: Over the last decade, an elaborate medical organization has evolved to provide acute care for injured persons at the finish line of the Boston Marathon. The medical team consists of physicians, nurses, podiatrists, physical therapists, athletic trainers, and other nonmedical personnel. The team believes that the most important cause of race injuries is fluid volume depletion; therefore, severely symptomatic athletes are treated early with intravenous fluids. In addition to the medical care team, an ancillary group has been established to maintain medical records, which help to define patterns of injury, thus allowing for more precise planning of medical care. The objective of both groups is not only to improve care at the finish line but also to identify ways to prevent injuries.
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