| Excess drinking water in excess can cause hyponatremia especially among runners. |
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Dr Lewis G Maharam, the medical director for the New York City Marathon and marathons in San Diego, Phoenix, Nashville and Virginia Beach, said he was taking every opportunity this year to educate runners about the biggest threat to their lives on race day-drinking too much water.
He knows the danger: In their zeal to avoid becoming dehydrated, runners may end up drinking so much that they dilute their blood. Water rushes into cells, including cells of the brain. The swollen brain cells press against the skull, and the result can be fatal. The resulting condition is known as hyponatremia-too much water.
"There are no reported cases of dehydration causing death in the history of world running", Maharam said. "But there are plenty of cases of people dying of hyponatremia. "No one knows how many have died, said Dr Arthur Siegel, the chief of internal medicine at McLean Hospital in Belmont, and the designated hyponatremia team leader for recent Boston Marathons. But he said that perhaps a dozen hyponatremia deaths had been recognised, according to informal communications among doctors at recent marathons. So this year, for the first time, the participant handbook for the November 6 New York City Marathon tells them how much to drink-no more than eight ounces of water every 20 minutes.
Maharam also makes sure the message is delivered via television shows that feature news about the marathon. He makes an announcement at the start of the marathon about how much to drink. And there will be a flier in the goody bags telling each runner, once again, of the dangers of drinking too much.
Even though Gatorade is one of the sponsors and the race features Gatorades new sports drink, Gatorade Endurance Formula, Maharam said that sports drinks were no better than water. Eight ounces of fluid every 20 minutes is plenty But it is a message that is not always heard. Last year, one per cent of the more than 35,000 New York City marathoners developed hyponatremia, Maharam said, and although that is a smaller toll than in other cities marathons, doctors say every one of those life-threatening medical emergencies could have been avoided.
To make matters worse, treatments for hyponatremia are often disastrous. Some doctors mistakenly think the runner is dehydrated and give intravenous fluids.
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