PurposeExercise‐associated hyponatremia (EAH) is common in ultra‐endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra‐endurance competitions.MethodsMedical records with sodium concentrations (n = 3138) from the IRONMAN® World Championships over the timeframe of 1989–2019 were reviewed for both male (n = 2253) and female (n = 885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations.ResultsWhen comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight.ConclusionsAltered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life‐threatening complications.

RESULTS: Patients were 80.0 ± 9.1 years old, 71.9% were female, they had 1.9 ± 1.3 previous fall-related injuries, and they sustained 0.5 ± 0.9 falls during the tracking period. With confounders held constant, each additional previous fall predicted a 3.9-fold increase in the odds of experiencing a future fall (p < 0.001; 95% CI of OR: 3.131 to 4.961); the overall model was significant (p < 0.001; pseudo R 2 = 0.460). Age (p = 0.351) and sex (p = 0.236) were not significant predictors. Holding the same confounders constant, negative binomial regression found each additional previous fall to predict a 94.9% increase in the number of future falls (p < 0.001; 95% CI of IRR: 1.728 to 2.198); age (p=0.283) and sex (p=0.163) were not significant. CONCLUSIONS: Our findings highlight the importance of screening older adults for a history of falls prior to exercise prescription. For clients and patients who report experiencing a fall, it may be prudent to incorporate safe forms of balance and stability training.

PurposeThis study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events.MethodsWe quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter.ResultsWe analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7–226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6–267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8–294.4) presented to the medical tent at higher rates than middle-age adults (36–69 yr; 180.1/1000, 95% CI = 175.4–185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9–253.2 vs 198.0/1000, 95% CI = 193.4–202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2–451.6) and nausea (400.4/1000, 95% CI = 388.4–412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8–496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1–123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7–19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature.ConclusionsUltraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.