An EMT is providing care to a patient who was halfway through running a marathon and is confused. Which problem should be suspected?

When treating a patient who is experiencing confusion during a marathon, exercise-associated hyponatremia should be suspected due to its connection with excessive fluid intake and dilution of sodium levels in the blood. This condition often occurs in endurance athletes who may drink large amounts of water without adequately replenishing electrolytes.

Confusion and altered mental status are common symptoms that can result from the rapid drop in sodium concentration, leading to cerebral edema and neurological disturbances. The risk of this condition is heightened in a marathon setting where fluid consumption may not be properly balanced with electrolyte intake.

In the context of other potential issues, generalized hypothermia is less likely in a marathon scenario, especially if the weather is warm or typical for running events. High-altitude pulmonary edema and acute mountain sickness do not typically present in a situation like a marathon unless the event is taking place at high elevations, which is uncommon for most standard races. Therefore, the presentation aligns most closely with the characteristics and risks associated with exercise-associated hyponatremia.