Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons.

OBJECTIVE: Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. METHODS: This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. RESULTS: The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. CONCLUSIONS: The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

A prospective randomized blister prevention trial assessing paper tape in endurance distances (Pre-TAPED).

OBJECTIVE: Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. METHODS: This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. RESULTS: One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. CONCLUSIONS: Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

A prospective cohort study of acute kidney injury in multi-stage ultramarathon runners: the Biochemistry in Endurance Runner Study (BIERS).

The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.

Performing Arts Medicine.

Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care.

Examination and treatment of pediatric injuries of the hip and pelvis.

Injuries to the hip and pelvis are the least common of lower extremity injuries in youth sports, but include many of the more serious conditions. This article describes the bone and soft-tissue conditions of the hip and pelvis that may present to health care providers caring for the pediatric and adolescent sporting population. The article discusses epidemiology, mechanisms, clinical presentation, evaluation, and treatment options.

An unusual cause of ischemic claudication: a case report.

A 56-year-old woman with a chief complaint of left lower-extremity numbness was referred by her gynecologist to the physical medicine clinic for workup of presumed lumbosacral radiculopathy. She had no history of low back pain, and her symptoms were elicited only with exercise. Results of her neurologic examination and lumbosacral radiographs were normal. Her medical history was significant for advanced cervical cancer, successfully treated with local surgery followed by high-dose pelvic radiation and chemotherapy 2 years before the current onset of symptoms. Subsequent workup with Doppler and arteriogram studies discovered a 3-cm area of diffuse stenosis of the left external iliac artery for which she was successfully treated with balloon angioplasty. This case presents an unusual cause of left leg claudication secondary to left iliac artery stenosis 2 years after pelvic radiation for cervical cancer and shows the necessity for a detailed evaluation of patients' medical histories.