Overconsumption is the most significant concern associated with water consumption during marathons. Drinking excessive amounts of fluid during a race can lead to dilution of sodium in the blood, a condition called exercise-associated hyponatremia, which may result in vomiting, seizures, coma and even death. Dr. Lewis G. Maharam, medical director for the New York City Marathon, stated in 2005: "There are no reported cases of dehydration causing death in the history of world running, but there are plenty of cases of people dying of hyponatremia."