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All the marathoners in the study had taken drugs such as aspirin, ibuprofen and naproxen sodium.

"Research has shown that ibuprofen (Advil and Motrin), ketoprofen (Orudis), and naproxen sodium (Aleve) affect kidney function. So only acetaminophen (Tylenol) should be used after midnight on race days," says Maharam. "But all of them are good for muscle pain afterward, once nausea has resolved and urine is clear yellow."

Maharam cautions that women are at special risk of depleting their sodium levels. "Women appear to have a higher risk for sodium depletion than men, but not because of physiology," he says. "Most first-time marathoners are women and they're still learning. Fortunately, most women don't develop any symptoms."

But for those who do, medical personnel use a standard protocol for exercise-related collapse. "We use a series of simple techniques to stimulate blood flow to vital organs," says Maharam. "But if racers don't feel better after 30 minutes, we transport them to a local hospital."

Before local marathons, emergency physicians are briefed on patient care.

"We treated and released four women with sodium loss during a recent marathon," Sterling Huff, DO, tells WebMD. The medical director of emergency services at Houston's St. Joseph's Hospital adds, "But we were coached to check sodium immediately, and it made a big difference in patient outcomes."

Vital Information:

  • Sodium loss from intense exercise can cause excess fluid in the brain and lungs. Symptoms include nausea, vomiting, headache, seizures, and large amounts of pink saliva.
  • Emergency treatment includes intravenous therapy with salt solution.
  • To prevent sodium loss, marathoners should use table salt before races, consume sports drinks during races, and eat salted pretzels in the second half.
  • Some over-the-counter pain medications such as ibuprofen, ketoprofen, and naproxen sodium affect kidney function; only acetaminophen should be used after midnight on race days.


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