A healthy 38 year old man finished the 2004 London marathon in just over five hours. During the evening celebrations, he had “two gins” and collapsed to the floor hitting his face on the pavement (fig 1).

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Figure 1

 Results of the patient hitting his face on the pavement.

Despite regular fluids during the race and food afterwards, five hours of continuous exercise would have caused hypovolaemia, hypoglycaemia, and reactive insensitivity of the leg veins to the shifts in blood volume which occur on standing. These changes combined with the vasodilatory effects of alcohol would cause orthostatic intolerance. He fainted.

The London marathon attracts thousands of amateur runners who should be warned of the dangers of post-race celebrations.