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Marathon runner's death linked to excessive fluid intake
The Boston Globe ^ | 8/13/2002 | Stephen Smith

Posted on 08/13/2002 6:23:01 AM PDT by Fractal Trader

The 28-year-old runner who collapsed and died in this year's Boston Marathon was felled by a precipitous cascade of medical events brought on in part by drinking too much fluid, the state medical examiner's office concluded yesterday.

Cynthia Lucero, who in the week before the April marathon completed her doctoral dissertation on how marathons help runners grieve, died from a condition known as hyponatremic encephalopathy, which happens when the brain becomes swollen because of a critical imbalance of sodium. She was only the second runner to die in the 106-year history of the race.

''This is a relatively rare catastrophic complication,'' said Dr. Ronenn Roubenoff, associate professor of medicine and nutrition and director of human studies at the Jean Mayer USDA Human Nutrition Research Center at Tufts University. ''It really is a tragedy because it's such a preventable thing.''

For the neighborhood jogger taking to the baking pavement in the August heat, the death of Lucero provides a graphic illustration of the dangers of drinking too much water or even sports drinks. Runners have long known the importance of replenishing fluids, but they may not know that it is also vital to maintain a balance in sodium levels to keep cells healthy. If runners drink too much fluid, they can dangerously dilute their blood sodium levels.

That condition is called hyponatremia. Although people seldom die from hyponatremic encephalopathy, health-threatening sodium deficiencies are more common among athletes than doctors once believed. Roubenoff cites one study, for example, that tracked 18,000 marathoners and found that among those seeking medical care after the race, 9 percent suffered from the condition. Deaths are sufficiently rare that specialists can recount them individually.

Until recently, hyponatremia was a little-known, even less-understood medical condition. But researchers, including Dr. Arthur J. Siegel of McLean Hospital, are learning more about hyponatremia, known more commonly as water intoxication.

Siegel is deeply familiar with Lucero's case, having obtained with her parents' permission a blood sample drawn at Brigham and Women's Hospital, where the runner was taken after she collapsed. He and other scientists are hopeful that, in death, Lucero will yield medical evidence that can prevent other runners from the fate that befell her.

''We want as Cynthia's legacy a better understanding of this problem so that we can work out strategies to make it less likely that these cases will happen in the future,'' said Siegel, director of internal medicine at McLean.

The 2002 Boston race was Lucero's second marathon. The previous one was two years earlier in San Diego, a race she completed in about 41/2 hours. She was running the Boston Marathon to raise money for the Massachusetts chapter of the Leukemia and Lymphoma Society. On that April Monday, friends tracked her progress. They said that Lucero, wearing bib number 15,611, drank large amounts of Gatorade and looked well as she loped through the bottom of Heartbreak Hill in Newton, about six miles from the finish.

But with Cleveland Circle in sight, Lucero began to falter, those friends recalled. One of them hopped into the race next to her and Lucero told the friend that she felt dehydrated and rubber-legged. Lucero tumbled to the pavement. When she reached Brigham and Women's, she was comatose.

Lucero's parents, who'd traveled from Ecuador to mark the completion of her dissertation, had been waiting at the finish line.

The precise causes of the syndrome that killed Lucero remain somewhat mysterious, and dispute persists among researchers over whether the predominant triggering mechanism is related to too much fluid or extreme dehydration. Increasingly, though, scientists believe that the problem transcends a simple equation of too much or too little water.

They believe it's vastly more complex. Siegel and other researchers theorize that marathoners, triathletes, and other athletes who engage in extreme sporting competition often deplete the fuel that powers the body's cells. When this happens, a hormone called arginine vasopressin gets released. Part of its function is to tell the kidneys to hold on to fluids. That, in turn, precipitates an imbalance in sodium levels in the blood. But as salt drops in the blood, it does not do so in cells. The body, in its constant pursuit of equilibrium, attempts to force salt out of cells by flooding them. That causes swelling. Muscles can endure such swelling because they can bulge outward. The brain, though, cannot.

''The brain lives in a box - the skull - and it doesn't have anywhere to go when this swelling starts,'' Roubenoff said.

Lucero's death showed that even runners who drink sodium-laden sports drinks remain at risk of the condition, which Siegel cites as evidence that the syndrome is more complicated than simply taking in too much fluid. That is why he and people who organize races are working on ways to improve measures of runners' health, including weighing them before and after races to make sure they haven't lost too much fluid or, conversely, consumed too much.

''We are moving toward understanding this problem,'' Siegel said, ''and if we can make some headway, maybe we can prevent more losses like Cynthia's.''

(Excerpt) Read more at boston.com ...


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Sad story.

However, one more story indicating the potential fatal dangers of excessive fluid intake.

1 posted on 08/13/2002 6:23:01 AM PDT by Fractal Trader
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To: Fractal Trader
Sounds like a job for the Dihydrogen Monoxide Research Division
2 posted on 08/13/2002 6:27:27 AM PDT by Wolfie
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To: Fractal Trader
completed her doctoral dissertation on how marathons help runners grieve

And she had such a bright future in today's high tech economy...

3 posted on 08/13/2002 6:30:57 AM PDT by Tijeras_Slim
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To: ironman
ping
4 posted on 08/13/2002 6:32:04 AM PDT by Drango
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To: Fractal Trader
''We want as Cynthia's legacy a better understanding of this problem so that we can work out strategies to make it less likely that these cases will happen in the future,'' said Siegel, director of internal medicine at McLean.

Is it just me, or does this statement seem both insipid and presumptuous? (And while I'm on the subject, Siegel had best be related to the family if he's stating such vacuous drivel on their behalf.)
5 posted on 08/13/2002 6:33:56 AM PDT by Xenalyte
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To: Xenalyte
Perhaps naming a juice bar after her would give closure. < /sarcasm>
6 posted on 08/13/2002 6:35:32 AM PDT by Tijeras_Slim
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To: Xenalyte
In general, I'd like to see a moratorium placed on the practice of the grieving process taking the form of national policy lobbying.
7 posted on 08/13/2002 6:39:04 AM PDT by Wolfie
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To: Wolfie
Sounds like a job for the Dihydrogen Monoxide Research Division

Yes, that's such an insidious chemical! Something must be done! [LOL]

8 posted on 08/13/2002 6:54:48 AM PDT by mhking
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To: Fractal Trader
Cynthia Lucero, who in the week before the April marathon completed her doctoral dissertation

This was the real cause of death, IMHO. Undertraining due to trying to complete 2 projects that require full attention.

9 posted on 08/13/2002 7:01:37 AM PDT by Oschisms
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To: Wolfie
Not to make light of the tragedy of this young woman's demise, it would behoove us as a nation, to ban these types of sporting events. The danger is just too high, the events are not necessary and, "As a nation, we should raise the national dialogue on these senseless and unnecessary deaths--if it would save just one life..."

Signed, any liberal
10 posted on 08/13/2002 7:02:46 AM PDT by Auntie Mame
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To: Fractal Trader
Runners have long known the importance of replenishing fluids, but they may not know that it is also vital to maintain a balance in sodium levels to keep cells healthy. If runners drink too much fluid, they can dangerously dilute their blood sodium levels.

The key, as it is in just about everything is moderation. Yeah, the fluids including the 8-10 glasses (or more) of water are important. But we've got the mindset that all salt is a bad thing. It's not. It's necessary. We've also got the mindset that all fat is a bad thing. It's not.

11 posted on 08/13/2002 7:06:29 AM PDT by Corin Stormhands
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To: dighton; aculeus; general_re
Cynthia Lucero, who in the week before the April marathon completed her doctoral dissertation on how marathons help runners grieve.
12 posted on 08/13/2002 7:09:18 AM PDT by Orual
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To: Tijeras_Slim
Irony.
13 posted on 08/13/2002 7:12:38 AM PDT by RedBloodedAmerican
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To: Orual; Tijeras_Slim; dighton; aculeus
...how marathons help runners grieve.

By giving you a way to join your dearly departed loved ones, apparently...

14 posted on 08/13/2002 7:22:28 AM PDT by general_re
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To: Fractal Trader
Isn't the story that the original runner from Marathon arrived in Athens with news of the battle (or was it of the arrival of the Persians?) and then dropped dead?
15 posted on 08/13/2002 7:43:12 AM PDT by aristeides
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To: Tijeras_Slim
completed her doctoral dissertation on how marathons help runners grieve

This has to go to the top of my current list of ironies.

16 posted on 08/13/2002 7:51:25 AM PDT by GretchenEE
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To: Fractal Trader
Incidentally, a lot of ravers die in this manner. Ecstacy makes you excessively thirsty.

But don't tell users that, because it's 'harmless fun.'

17 posted on 08/13/2002 7:52:11 AM PDT by Skwidd
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To: Corin Stormhands
bump for your post @ 11.

My mom used to quote this constantly to us whelps: "Moderation in all things." As with many other of the things she said, I didn't really grasp the depth of the wisdom till adulthood.
18 posted on 08/13/2002 7:55:56 AM PDT by GretchenEE
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To: aristeides
It was news of the victory the Hellenes had over the Medes. Legend says the message was "Rejoice! We Conquer!". There is no real documentation of the run, so while a foot courier may have been dispatched to carry news to Athens, we really don't know what the real message, if any, was. Further, given the skill of the Greeks at long distance running, it is unlikely he would have died.

A true stroy about the Battle of Marathon involves Philippides, who ran from Marathon to Sparta to enlist Spartan soilders to fight along the Athenians. However, the Athenians attacked and won before the Spartans arrived. The distance from Marathon to Sparta is about 150 miles, and Philippides coverd this distance in less than two days, on foot.
19 posted on 08/13/2002 8:37:11 AM PDT by jae471
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To: Orual; dighton; general_re
... drank large amounts of Gatorade ...

Pepsico (owner of Gatorade) lawyers are now composing new warning labels.

Meanwhile from Gatorade's web site:

TOO MUCH OF A GOOD THING CAN BE BAD, EVEN TOO MUCH WATER." -Randy Eichner, M.D.

While most runners and cyclists know the importance of hydrating, some don't realize overhydrating can dangerously lower blood sodium levels-a condition known as hyponatremia.

Hyponatremia seems most common in female and beginning marathoners and triathletes for two reasons, says Randy Eichner, M.D., professor of medicine and team physician at the University of Oklahoma and volunteer physician at the Hawaii Ironman Triathlon. One, they are on the race course for many hours, losing lots of sodium in sweat. Two, they are hypervigilant about staying hydrated. "They drink lots of water in the days before the race, then stop at every fluid station along the course," he says.

"Drinking is important, but the problem is they drink too much water."

20 posted on 08/13/2002 10:31:40 AM PDT by aculeus
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