near tragedy (Page 2)

As TriToy said, dehydration and hyponatremia can look similar, but in this case the evidence
points to hyponatremia.

Originally posted by lebowski

I just got back from IMKY where my son competed in the event . At mile 13 of the run, he collapsed. When I got to him, he had the appearance of dehydration; dry mucous membranes, no urine output, severe cramping, etc. I immediately tried to hydrate him with water, about 30 ounces. After about 20 minutes, no improvement so we went to medical. In medical ,he was given Normal saline for 2 liters . I insisted they check a set of electrolytes and his sodium was 123. After no improvement, we went to the local hospital. To make a long story short, he had a seizure and was admitted to ICU. His ct originally showed cerebral edema. After 3 days he woke up and is now fine. His nutrition was on the bike, 3 gels, granola bar and 1 or 2 bottles of water an hour. on the run , 2 gels, 1 granola bar per hour with 3 cups of water and 1 or 2 electrolyte solution per mile. the run was 92 degrees with 60-70 humidity. He is 6'4 about 150. Also, he had a CK max of !8,000 that maxed after 3-4 days. I would appreciate any help with this.

Originally posted by dtoce
do you have a good source that you recommend for the race fluid and electrolyte needs? My coach says no more than 250 cal per hour and the fluid is variable.


I think it is important to expand on the comment: 'dehydration and hyponatremia look similiar'.


We are talking about athletes who are racing and therefore undergoing loss of body fluid via
sweat/heat production. Their water metabolism and electrolytes get messed up, they get dehydrated and
try to fix this by drinking water and electrolyte solutions during the race.

Figuring out nutritional and fluid needs during a race is the important 4th discipline.
(There is a lot of information about this elsewhere...)

Often, the rehydration is too much and the blood sodium becomes low. This is actually called
'exercise associated hyponatremia'. We are not talking about people who are hyponatremic BEFORE the race.
They become volume depleted and dehydrated, variably, during the race.

Many athlete's are likely a bit dehydrated and hyponatremic after races. (You don't know someone's blood
sodium level without a blood test, but you can get an ideal of their hydration status by looking at the urine or
knowing the change in your weight.)

Of the people who are were dehydrated, some people become hyponatremic with excessive water intake
and possibly due to ADH secretion. I will not go into mechanism of action etc, but these people were previously
dehydrated and some (I believe one of the Boston marathon studies quoted ~13% of runners in their study, with
studies ranging from 0-18%) became hyponatremic=low serum sodium. This was more likely to occur with duration
of the activity-ie 5 hr marathoners were more likely to have this occur than 3 hr marathoners. The incidence in
ultra runners is much higher.

The problem comes with volume repletion. In fact, without adequate testing, you really do not know whether the
sodium is high or low. Hypernatremia was more common than hypo in several studies of collapsed athletes due to
loss of water>salt. These people were still volume depleted and needed IVF's.

The current recommendation during races is to drink when you start to get thirsty. Many athletes overdo it and many
do not hydrate well enough. We all should learn to manage our fluids better.

If hyponatremia is documented after the race, and there is no sign of severe neuro symptoms, then the actual first
treatment is fluid restriction, due to previous overhydration and dilution of the sodium present in the vascular space
(and often the presence of ADH.) Hypertonic saline can be given by those experienced with it and it is usually only
small doses...

As I have already said, people need to become better in tune with their bodies and make good decisions about
hydration/nutrition-especially during hot weather.

I am very glad he is ok, and I'm sure I'd have been very nervous if it were my son having a seizure after a race.

Originally posted by lebowski

do you have a good source that you recommend for the race fluid and electrolyte needs? My coach says no more than 250 cal per hour and the fluid is variable.

Originally posted by lebowski

my coach says to take no more than 250 cal per hour. Your estimates on the fluid is about what I do. Its good to know that others get nauseated at the end of the bike. Do you just keep up the same plan during the run ? All of this is great info, thanks

Originally posted by lebowski

....... Stupid is as Stupid does.

Originally posted by lebowski

my coach says to take no more than 250 cal per hour. Your estimates on the fluid is about what I do. Its good to know that others get nauseated at the end of the bike. Do you just keep up the same plan during the run ? All of this is great info, thanks

Originally posted by lebowski

actually he was very regimented on his nutrition. Those numbers were my recollection. I wrote this, not him. As for the 250 cal/hour, he says that is due to absorption. I do agree that we all need more help on this , that is why I posted.

Originally posted by lebowski powergel 200 mg Na/ gel pack x3 600mg Na the granola bar was a peanut salt and sweet bar with 100mg 2-4 endurolytes per hour 80-160 mg so on the average, he took 780-860 mg Na per hour. He followed the advanced Fink plan.