General Discussion Triathlon Talk » Interesting observations from 70.3 medical tent re: sodium Rss Feed  
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2012-04-02 2:20 PM

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Subject: Interesting observations from 70.3 medical tent re: sodium

So, yesterday for the Memorial Hermann Ironman 70.3 Texas race I worked in the medical tent and took care of a lot of dehydrated, hot, tired folks. I work as an ER nurse for Memorial Hermann in our flagship Level 1 hospital and the med tent was captained by one of our physicians and ER managers. I was very surprised by some of the things that I learned and saw that were unexpected.

We had the pleasure of having an Istat machine so just about everyone that came in who we were giving IV fluids to we were able to send a quick set of electrolytes and have results in about a minute or two. These results are what were surprising. In triathlon, especially longer course racing we always hear of hypo or even sometimes hypernatremia being the culprit for a lot of the problems that we have on the course related to cramping, dizziness, etc. Of all of the labs we ran (quite a few, don't have solid numbers yet) I did NOT see one since sodium value outside of the normal range. Not one. I did have a lot of athletes though that complained of symptoms that would make you think "oh, their sodium is probably low."

What I did see were a lot of results showing solid dehydration, acute renal failure, and a few cases of high potassium. I'm not quite sure what to make of these results yet but I will be doing a lot more research for sure.

Information about the day: it was pretty warm, mid 80's, sunny for the most part with some early cloud cover, and a good bit of wind. There is a pretty decent part of the run course that has zero shade.

I'm sure the results would be different in a full 140.6 and could also be much different with hotter conditions and so forth. I was just surprised because the symptoms were the same, there was no shortage of the ominous dried salt all over black shorts, etc, with no resulting sodium abnormalities.

What say you BT?



2012-04-02 2:28 PM
in reply to: #4125215

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Champion
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
I vote for absolutely no surprise.

Shane
2012-04-02 2:32 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
Too much reliance on sports drink, not enough plain water.
2012-04-02 2:34 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

gsmacleod - 2012-04-02 3:28 PM I vote for absolutely no surprise. Shane

x2.  It is pretty well established that plasma sodium concentration is maintained within a narrow range despite wide variations in sodium and water intake.

2012-04-02 2:35 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

I'm not really surprised that you saw sodium levels in the normal range.  People are pretty aware of the risk of hyponatremia these days.  Some even go overboard with the sodium IMO, but you rarely see it the other way around.

I am a little surprised you had a lot of people in the medical tent when the temp was only mid 80s.

2012-04-02 2:39 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
LukeTX04 - 2012-04-02 2:20 PM

So, yesterday for the Memorial Hermann Ironman 70.3 Texas race I worked in the medical tent and took care of a lot of dehydrated, hot, tired folks. I work as an ER nurse for Memorial Hermann in our flagship Level 1 hospital and the med tent was captained by one of our physicians and ER managers. I was very surprised by some of the things that I learned and saw that were unexpected.

We had the pleasure of having an Istat machine so just about everyone that came in who we were giving IV fluids to we were able to send a quick set of electrolytes and have results in about a minute or two. These results are what were surprising. In triathlon, especially longer course racing we always hear of hypo or even sometimes hypernatremia being the culprit for a lot of the problems that we have on the course related to cramping, dizziness, etc. Of all of the labs we ran (quite a few, don't have solid numbers yet) I did NOT see one since sodium value outside of the normal range. Not one. I did have a lot of athletes though that complained of symptoms that would make you think "oh, their sodium is probably low."

What I did see were a lot of results showing solid dehydration, acute renal failure, and a few cases of high potassium. I'm not quite sure what to make of these results yet but I will be doing a lot more research for sure.

Information about the day: it was pretty warm, mid 80's, sunny for the most part with some early cloud cover, and a good bit of wind. There is a pretty decent part of the run course that has zero shade.

I'm sure the results would be different in a full 140.6 and could also be much different with hotter conditions and so forth. I was just surprised because the symptoms were the same, there was no shortage of the ominous dried salt all over black shorts, etc, with no resulting sodium abnormalities.

What say you BT?

You mentioned what it (the test) didn't show. What did the testing show?



2012-04-02 2:41 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

Those results don't surprise me at all. I have noticed the same type of results. The slightly elevated K+ is usually from hemolysis, muscle breakdown or slightly acidic state.

Electrolyte replacement has value but not to the extent the "Marketing Company" want you to believe.

The severe hyponatremia that we hear about is due to the complete breakdown of the bodies natural homeostatic mechanisms and can not be treated by oral supplements. It can also be fatal. Fortunately you did not see any.

2012-04-02 2:50 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

What about the blood glucose levels?  As a T1 diabetic, that's my number one stat and can cause dizziness (hypo) or cramping (hyper).  Just curious if you see it play any role with non-diabetic folks suffering those symptoms.

2012-04-02 2:51 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
tjfry - 2012-04-02 1:39 PM

You mentioned what it (the test) didn't show. What did the testing show?



She did mention it...deydration, acute renal failure and a few cases of high potassium.

I hope your medical director is also PI and using the opportunity for some sort of study on endurance racing! I'd also be curious to know things like weight loss during the race, amount of fluid intake and serum creatinine values.

Fascinating. Racing well in the heat requires training well in the heat. Excellent that there are so few cases of low sodium in your experience yesterday...shows that some education of the endurance population is taking place since the original studies of hyponatremia were first published.

Would also be fascinating to see how the lab values varied based on the racers finishing times. In the orginal hyponatremia studies, it was the 4 hour marathoners having problems, not the sub 3 hour marathoners, even though they'd presumably be working relatively harder.
2012-04-02 3:01 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
I'm also interested in any BG data you might have gathered. do they check that in a Med tent? seems like it'd be an easy number to get.
2012-04-02 3:10 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

Interesting post..

I am very interested in this subject as I have serious issues in the high heat.  Last year at Eagleman I bonked on the run very hard, almost from the start. But my bike was fast. I took in what I thought was lots of fluids on the bike. ...  sports drink (cera sport) and water.  What was interesting is I did not cramp just felt exhausted from the heat (i assume

Hopefully this year will go better, going to experiment with a few things in training this year before the race. 



Edited by Grnfsh 2012-04-02 3:11 PM


2012-04-02 3:21 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
And why I never recommend supplementing with extra sodium.
2012-04-02 3:23 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
AdventureBear - 2012-04-02 2:51 PM
tjfry - 2012-04-02 1:39 PM

You mentioned what it (the test) didn't show. What did the testing show?

She did mention it...deydration, acute renal failure and a few cases of high potassium. I hope your medical director is also PI and using the opportunity for some sort of study on endurance racing! I'd also be curious to know things like weight loss during the race, amount of fluid intake and serum creatinine values. Fascinating. Racing well in the heat requires training well in the heat. Excellent that there are so few cases of low sodium in your experience yesterday...shows that some education of the endurance population is taking place since the original studies of hyponatremia were first published. Would also be fascinating to see how the lab values varied based on the racers finishing times. In the orginal hyponatremia studies, it was the 4 hour marathoners having problems, not the sub 3 hour marathoners, even though they'd presumably be working relatively harder.

I am planning on seeing what I can do in terms of collecting the data we gathered and analyzing it based on time, pace, etc. I don't know if it will be possible though because it could be considered protected health information. As far as creatinine numbers I was seeing a lot in the range of 2.1-2.4. I think the highest I saw was 2.9. 

Glucose values were all within normal range that I saw. The few cases of hyperkalemia that we saw were legitimate, not hemolysis. Repeats were roughly the same with resulting EKG changes as well. 

BTW AdventureBear, I'm not a she! lol.

2012-04-02 3:25 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

What others have mentioned where what I was getting at. What were the items tested and what were the results for those items. I don't know much about an istat machine, but would guess that it doesn't test/measure for acute renal failure. I'm less concerned or interested about sodium levels and more curious about the other findings. You can take the sodium stats in either direction. Because of the marketing efforts or education or luck or products on the course, you could argue that most out there were taking more than enough electrolytes and not enough fluid. Hence the results. Or you could say that electrolytes have much less value than we are lead to believe and hence the results. Everyone is going to have a take. Ask the docs in Kona and they will say electrolytes are important, Ask someone at Ironman Canada and they will say it's hogwash.

 

My question, which now that I think about it is a bit of a hijack, is more about all the interesting tidbits that popped up and less about sodium specifically. What did it test? Iron/hematacrit? Insulin? Calcium?

This would be a really cool thing to have at all WTC races and then publish the trends.

2012-04-02 3:34 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

Everyone is going to have a take. Ask the docs in Kona and they will say electrolytes are important, Ask someone at Ironman Canada and they will say it's hogwash.

They might've changed their minds at Canada last year

2012-04-02 3:35 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

TJ,

We got the basic electrolytes with a little more. Sodium, Potassium, Calcium, Glucose, BUN, Creatinine, Hemoglobin, Hematocrit. Now I would really like to see results from other races if this has been used. 

Luke



2012-04-02 3:41 PM
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Houston
Subject: RE: Interesting observations from 70.3 medical tent re: sodium
spudone - 2012-04-02 2:35 PM

I'm not really surprised that you saw sodium levels in the normal range.  People are pretty aware of the risk of hyponatremia these days.  Some even go overboard with the sodium IMO, but you rarely see it the other way around.

I am a little surprised you had a lot of people in the medical tent when the temp was only mid 80s.

It was pretty humid out there. I think humidity catches a lot of people off guard.

2012-04-02 4:09 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

while I do not have direct comments on the results I did want to say two things:

1rst - thanks for volunteering your time and skills to help out in the medical tent. I am sure all that showed up were grateful to have you around!

2nd - I really appreciate you bringing this to our attention and would second others who think these actual results would make for some fantastic studies on race results/symptomology and body chemistry. Of course for accuracy you would have to have volunteers get blood drawn before the race and after the race/when the pull out of the race if unable to continue and getting weight would also be a good idea. Add a survey looking that compares training time and nutrition and hydration type/frequency during the race and that would be a full fledged and awesome sports medicine study.

2012-04-02 4:30 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

Interesting information. As newer triathlete this is a little bit disconcerting. How do you figure out the best balance of electrolytes and water?

I am sure it's hard to know for sure but I will ask anyway, were the people in the tent under-prepared, pushing too hard, both? Or were they prepared and just didn't get the hydration/nutrition right? Answer is probably somewhere in the middle but I thought it would be interesting to hear what the athletes said and your impressions.

2012-04-02 4:34 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
johnyutah5 - 2012-04-02 4:30 PM

Interesting information. As newer triathlete this is a little bit disconcerting. How do you figure out the best balance of electrolytes and water?

I am sure it's hard to know for sure but I will ask anyway, were the people in the tent under-prepared, pushing too hard, both? Or were they prepared and just didn't get the hydration/nutrition right? Answer is probably somewhere in the middle but I thought it would be interesting to hear what the athletes said and your impressions.

Yes. All of the above. I had a lot who told me that they just pushed too hard and left everything on the course. Had one tell me that he didn't drink a single thing on the bike because he was pushing hard and passing everyone and had another tell me that he lost his nutrition bottle on the bike and that threw him all off. Also had a few tell me that they were just simply not prepared and properly trained for the distance.

2012-04-02 4:49 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
LukeTX04 - 2012-04-02 4:34 PM
johnyutah5 - 2012-04-02 4:30 PM

Yes. All of the above. I had a lot who told me that they just pushed too hard and left everything on the course. Had one tell me that he didn't drink a single thing on the bike because he was pushing hard and passing everyone and had another tell me that he lost his nutrition bottle on the bike and that threw him all off. Also had a few tell me that they were just simply not prepared and properly trained for the distance.

 I don't have a medical background, so I haven't chimed in on this thread--but found it interesting. Thanks.

That's just crazy that the one guy didn't drink anything on the bike. Wow.  



2012-04-02 5:35 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
LukeTX04 - 2012-04-02 3:35 PM

TJ,

We got the basic electrolytes with a little more. Sodium, Potassium, Calcium, Glucose, BUN, Creatinine, Hemoglobin, Hematocrit. Now I would really like to see results from other races if this has been used. 

Luke

So would I. I bet the results around the world would be as different (and correlate with)  as the temps the race was run in. If you are able to get your hands on the data, be sure to share.

2012-04-02 6:05 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
tjfry - 2012-04-02 6:35 PM
LukeTX04 - 2012-04-02 3:35 PM

TJ,

We got the basic electrolytes with a little more. Sodium, Potassium, Calcium, Glucose, BUN, Creatinine, Hemoglobin, Hematocrit. Now I would really like to see results from other races if this has been used. 

Luke

So would I. I bet the results around the world would be as different (and correlate with)  as the temps the race was run in. If you are able to get your hands on the data, be sure to share.

I am confused why you would think the results would be different? Normal is normal. The sodium levels that are drawn immediately after an endurance event are almost always normal. 12 to 24 hours later when the body equilibrates is when you may see a differences

2012-04-02 6:25 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium
I think a lot of the "salt on the shorts" syndrome is from the saltwater swim. You often see it on the bike soon after an ocean swim where it didn't even have time to build up from perspiration.
2012-04-02 6:47 PM
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Subject: RE: Interesting observations from 70.3 medical tent re: sodium

Rickz - 2012-04-02 7:25 PM I think a lot of the "salt on the shorts" syndrome is from the saltwater swim. You often see it on the bike soon after an ocean swim where it didn't even have time to build up from perspiration.

You also see it a lot on routine bike rides over 60 miles in the heat without swimming

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