Hyponatremia- Mechanism and Prevention

With the recent death of a high school football player suspected of dying from hyponatremia after consuming 4 gallons of fluid after a football practice, it becomes essential to establish individualized hydration plans.

Hyponatremia, or water-intoxication in laymen’s terms, is a medical condition in which the sodium levels in the blood fall dangerously low, and if not treated for immediately, can be fatal. This is most commonly seen in long endurance events such as marathons, especially in runners with finish times greater than 4 hours, but can also occur in any sport. 

Hyponatremia can occur two ways: 1) athletes drink too much water (or other drinks low in sodium) than what they can lose via sweat or 2) athletes lose too much sodium in their sweat. Hyponatremia can be suspected if an athlete finishes a race or practice weighing more than when they started, but with the latter case above, it is not always the case.

All athletes have individualized hydration needs. Each person varies in their sweat rate during exercise and the concentration of sodium they lose via sweat. Since these measures vary in all persons, it is essential to establish individualized hydration strategies for each individual athlete. Below are some steps that can be used to find out individual hydration needs during exercise:

1) Before a workout, make sure you are hydrated (light colored urine) as being dehydrated will affect normal sweat rate

2) Take a nude body weight before the workout.

3) Exercise for 1 hour (mode and intensity of exercise would be something you would typically do on a normal basis)

4) During the one-hour workout refrain from drinking fluids as this will affect sweat rate. If water is consumed weigh the water before and after the workout and record the difference

5) After the workout take another nude body weight and calculate the difference between pre and post exercise. If water is consumed during exercise subtract the water weight from the post exercise weight.

6) For every 2.2 pounds a person loses it will equate to 1 liter of fluid loss (sweat loss). For example, if someone loses 5 pounds in 1 hour their sweat rate is 5/2.2=2.27 liters/hour.

7) A persons sweat rate is the amount of fluid they will need to replace during exercise. For heavy sweaters it is not uncommon to be unable to drink everything you lose during the workout and fully replacing fluid losses will have to occur after exercise.

As with sweat rates, sodium needs during exercise are also individualized. If you notice that after a workout you have white rings outlining the areas of sweat on your clothes or if you have white streaks on your face, you may be a “salty sweater.” In these cases, you may need to consume more sodium either in your diet or in your fluid during exercise. Although sports drinks do contain electrolytes, the concentration of electrolytes in the sports drinks do not completely prevent hyponatremia from occurring, so it may be necessary to add more salt to these drinks.

Individualized hydration plans not only add a safety precaution, but can also help maximize athletic performance. Starting an athletic event hydration, minimizing fluid losses, during, replacing fluids after exercise are important to keep the body functioning optimally. For those that are heavy sweaters or other situations where athletes are unable to replace fluid losses during exercise, replacing fluids post exercise is essential. Drinking fluids that contain carbohydrates and electrolytes post exercise will help restore electrolyte losses that occur during exercise in addition to helping retain the fluid that is consumed.

 

 

Got EAP?

It’s almost the start of a new school year, which means preparation in all of its forms is underway. As the fall sports season begins, it is important that injury prevention procedures are being put into place to ensure athlete safety. Some schools may already have these procedures implemented, while others are currently working towards them. One might ask, where do I begin? This question can be answered with three simple words: Emergency Action Plan (EAP).

The EAP is possibly the most important component to injury prevention, providing information to ensure that response to an emergency or catastrophic event is rapid, and well controlled. EAP defines responsibilities for everyone involved in the response to an emergency situation, as well as establish standard of care. As the school year begins, I challenge you to review your EAP, make any changes that could possibly enhance athlete safety, or implement them as a means of injury prevention if you have not already done so.

Why the challenge? A well-developed EAP can be the difference between life and death. Without one, your school or institution is at risk of being negligent in an emergency situation. If you’re questioning the EAP you currently have, or need assistance creating one, the National Athletic Trainers’ Association published a position statement on “Emergency Planning in Athletics” in 2002, which provides key points in developing EAPs.

The Korey Stringer Institute has also identified 7 key components to an effective EAP.

1. Emergency Personnel

2. Emergency Communication

3. Emergency Equipment

4. Medical Emergency Transportation

5. Venue Directions with a Map

6. Roles of First Responders

7. Emergency Action Plan for Non-Medical Emergencies

Please refer to the KSI website (http://ksi.uconn.edu/information/athletic-trainers/) for a detailed explanation of each component, as well as a sample EAP that can be used as a template for creating one of your own!

Here’s the true test. If a catastrophic event were to happen at your institution right now, would you be prepared? Do you have the necessary preparation and steps in place to save a life?

Let’s have your school specific EAP ready when you meet with your Athletic Director and coaches at the kickoff meeting for the upcoming school year!

Get Your Body Heat Acclimatized

As summer camps start to dwindle down, it’s about that time athletes begin to condition and get ready for pre-season. It’s time to bring out those cleats, clean the football pads, buy some new knee pads and soccer balls and most importantly washing those 15 water bottles for the season. Whether it be football, soccer, cross country or volleyball all athletes need to remember the importance of getting their body ready for the long conditioning sessions in the heat. Whether you are 14 and excited to get into high school or 38 preparing to train for your first ever marathon gradually entering into your exercise regimen during these dog days of summer, is vital to your health.

Heat acclimatization plays a large part in the body’s physical response to cope with heat exposure. Heat acclimatization refers to a series of changes in the body to heat stress over a period of 7 to 14 days. Performing an appropriately guided acclimatization program allows for reductions in heart rate, body temperature response, skin temperature response, perceived exertion and increases in sweat rate, sweat onset, heart function, and overall ability to perform in the heat.

The Korey Stringer Institute has set forth a list of suggested appropriate guidelines for heat acclimatization. This list of 7 suggested recommendations has been adopted by 13 states in the US. Aside from DC and West Virginia, the remaining states have some type of heat acclimatization guideline(s) yet are deficient when compared to the guidelines set forth by KSI. In the states that have passed the recommended KSI heat acclimatization guidelines, there have been zero deaths in high school athletics. Does your state have the appropriate guidelines in place? Are you comfortable playing sports in your state? If you are a parent, are you comfortable allowing your child to play high school sports without the appropriate guidelines? Now is the time to get involved with your state legislation and ensure safety for all athletes with the appropriate guidelines.

For more on the KSI suggested guidelines please visit our website! www.ksi.uconn.edu