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Thread: Medics: Is this for real?

  1. #1
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    Medics: Is this for real?

    I just read on the pinnacle ridge extreme race web site:

    “First aid kit (minimum contents: bandage, plasters, pain killers but please
    NO ANTI INFLAMMATORIES [NSAIDS] as these have been known to cause renal failure in race situations)”

    I’m aware of a correlation and increased risk of renal failure to nasaids in already compromised patients: I just looked it up. But if that risk were other than small they would not get a license as an OTC medicine.

    I am certainly not aware of competitors ever being carried away because of renal failure SPECIFICALLY because of use of nasaids in race situations as this implies.

    Questions. Is this exaggerating risk? Should RO even be making these judgements?
    Last edited by Oracle; 06-11-2019 at 10:14 AM.

  2. #2
    There is evidence to show that long distance running compromises kidney function and then the use of NSAIDS on top of that is the risk they are calling out.

    https://medicine.yale.edu/news-article/21511/

    The issue is linked to hydration levels

    If runners are wanting to mask pain / inflammation paracetamol is meant to be better

  3. #3
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    NSAIDs are not nice drugs - just because they are available OTC does not make them safe. My main concern in a runner doing something "extreme" would be a bleed from the upper gut. I can see that if someone develops a degree of AKI - acute kidney injury - during an event because of dehydration, then the NSAID could make it even worse, but in most cases the kidneys will recover fully in a few days, and the person affected will probably be unaware that anything significant had happened to their kidney function.
    Apart from upper gut bleeds and effects on kidney function, the other side effects of NSAIDs include heart attacks, strokes, masking the pain of important injuries, and reducing the effects of training on muscles/tendons.
    Reasons for taking NSAIDs? Acute gout, acute severe rheumatic conditions such as Ankylosing Spondylitis and Rheumatoid Arthritis; otherwise, as has been said, paracetamol is far safer.
    Last edited by Mike T; 07-11-2019 at 11:03 AM.

  4. #4
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    More long distance races are briefing against using NSAIDs. The Dragon's Back race do so quite strongly (but leave it in the runners hands for self-medication - race medics would never administer them)

    The London Marathon states:
    "Certain pain killers termed non-steroidal anti-inflammatory drugs (NSAIDS) such as brufen or naproxen can cause problems with the kidneys in states of dehydration and should be avoided within 48 hours of running the marathon. Muscular pain during this period should be treated with paracetamol."

    You sometimes wonder whether if you know the risks and mitigate against them (keeping well hydrated) if it's safe, but I think general consensus is coming to a point where it's best to not risk it.

    I know long distance runners who take them sometimes but they really keep an eye on hydration. In one team race a partner accidentally double-dosed on ibuprofen. We knew we were ~1.5h away from the next available water so took stock of our water reserves. The other 3 of us donated our water to the double-doser to keep his kidneys flushed.
    Last edited by ba-ba; 07-11-2019 at 10:14 AM.
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  5. #5
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    Thanks all.

    This makes interesting reading.
    A 24 hour track race led to an emergency.

    http://www.nbcnews.com/id/37341523/n.../#.XcPkBIqnzmo

    Ps they refer acetaminophen , to us is I think paracetamol.
    The OD limit is seemingly low.
    Last edited by Oracle; 07-11-2019 at 10:36 AM.

  6. #6
    Yes indeed. This is an illuminating and helpful thread.

    So back to Tincture of Turmeric?
    Last edited by Graham Breeze; 07-11-2019 at 11:11 AM.
    "...as dry as the Atacama desert".

  7. #7
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    Quote Originally Posted by Oracle View Post
    Thanks all.

    This makes interesting reading.
    A 24 hour track race led to an emergency.

    http://www.nbcnews.com/id/37341523/n.../#.XcPkBIqnzmo

    Ps they refer acetaminophen , to us is I think paracetamol.
    The OD limit is seemingly low.
    Acetaminophen is paracetamol. Maximum dose is 1 GM 4 times a day - as the article says, problems may arise when someone takes regular paracetamol at full dose, as well as paracetamol under a different name, or a mixed product which, unknown to them, also contains paracetamol. Liver failure may follow, and often by the time the person feels unwell, it is too late, and a liver transplant is needed.

    The article implies that NSAID induced renal problems may be prevented by avoiding dehydration - this of course may result in drinking so much that hyponatremia develops - not nice.

    Safer - by far - to avoid both these medications!

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