Collapsed Runners: Blood Biochemical Changes After IV Fluid Therapy

Noakes, Timothy D.; Berlinski, Neil; Solomon, Eric; Weight, Lindsay M.

doi:10.1080/00913847.1991.11702212

Cited by 14 publications

(6 citation statements)

References 15 publications

(1 reference statement)

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“…9,10 Overzealous intravenous rehydration, however, may lead to fluid-overload hyponatremia. 11 Oral rehydration has been shown to ameliorate thirst, 12 with the ingestion of sodiumcontaining beverages facilitating the restoration of fluid balance in the volume-depleted state. [13][14][15] This study was designed to address the following questions: (1) What is the incidence of hyponatremia, hypernatremia, and normonatremia in collapsed runners presenting to the medical tent of the Comrades Marathon, and did initial [Na + ] status influence time to discharge?…”

Section: Introductionmentioning

confidence: 99%

Dysnatremia Predicts a Delayed Recovery in Collapsed Ultramarathon Runners

Hew‐Butler

Sharwood²,

Boulter³

et al. 2007

Clinical Journal of Sport Medicine

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A slight majority of collapsed runners were normonatremic and spent significantly less time in the medical tent compared with hyper- and hyponatremic athletes. Initial rates of correction of hypernatremia were similar with intravenous and oral hypotonic fluid therapy. Clinicians should be advised that intravenous fluid resuscitation may best benefit hypernatremic collapsed runners who are intolerant to oral fluid ingestion.

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Section: Introductionmentioning

confidence: 99%

Dysnatremia Predicts a Delayed Recovery in Collapsed Ultramarathon Runners

Hew‐Butler

Sharwood²,

Boulter³

et al. 2007

Clinical Journal of Sport Medicine

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“…Figure 5. Speedy et al [16] found an inverse relationship between the weight lost during the race and the post race serum sodium concentrations. There was a wide scatter in the relationship so that athletes with the same serum sodium concentrations could show quite large differences in their individual degrees of weight change.…”

Section: The Studies Of Dr Dale Speedy and Colleaguesmentioning

confidence: 98%

“…Indeed serum sodium concentrations in affected athletes were usually well below 125 mmol.L -1 . Subsequently, it became apparent that the serum sodium concentrations of some athletes, perhaps as many as 10% of all participants completing ultradistance events [2,16,17], could drop below the clinically diagnostic value of 135 mmol.L -1 without causing symptoms. These athletes with asymptomatic hyponatremia were usually identified only by random blood testing while participating in other research projects [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Subsequently, it became apparent that the serum sodium concentrations of some athletes, perhaps as many as 10% of all participants completing ultradistance events [2,16,17], could drop below the clinically diagnostic value of 135 mmol.L -1 without causing symptoms. These athletes with asymptomatic hyponatremia were usually identified only by random blood testing while participating in other research projects [16,17]. These asymptomatic athletes therefore fulfilled the biochemical criteria for a diagnosis of hyponatremia, yet they were asymptomatic and were clearly not in the same dire physical condition as are athletes with symptomatic hyponatremia [2,18•].…”

Section: Introductionmentioning

confidence: 99%

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Hyponatremia in Distance Runners

Noakes¹

2002

Current Sports Medicine Reports

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Since its first description in 1985, two opposing theories have evolved to explain the etiology of symptomatic hyponatremia of exercise. The first holds that the condition occurs only in athletes who lose both water and sodium during exercise, and fail to fully replace their sodium losses. The second theory holds that the symptomatic form of this condition occurs in athletes who generate a whole body fluid overload as a result of an excessive fluid intake during prolonged exercise. It is argued that the promotion of the idea that athletes should drink as much as possible during exercise has produced, rather than prevented, the recent increase in the incidence of this condition. A series of case reports and laboratory studies reported in the past 2 years have established that it is a whole body fluid overload, resulting from sustained high rates of fluid intake, that causes the symptomatic hyponatremia of exercise. There is no evidence that, in the absence of fluid overload, the usual sodium deficits generated during exercise can cause this condition. These findings confirm that the potentially fatal condition of symptomatic hyponatremia would be eliminated from sport immediately if all athletes were advised of the dangers of ingesting as much fluid as possible during any exercise that lasts more than 4 hours.

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“…Others who believe that symptomatic hyponatremia results from overhydration (23,46,64,70,72,104) warn that this form of treatment will compound the basic abnormality and could be fatal (63,65,74).…”

Section: Clinical Featuresmentioning

confidence: 99%

The Hyponatremia of Exercise

Noakes¹

1992

International Journal of Sport Nutrition

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The hyponatremia of exercise may exist in symptomatic and asymptomatic forms. Symptomatic hyponatremia is usually characterized by severe alterations in cerebral function including coma and grand ma1 seizures; it develops especially in less competitive athletes who have maintained high rates of fluid intake during endurance events lasting at least 5 hours. The hyponatremia becomes symptomatic when the volume of excess fluid retained exceeds 2 to 3 liters. The etiology of the condition is unknown. Possibly as many as three or more pathologies (abnormal fluid retention possibly due to inappropriate ADH secretion, abnormal regulation of the extracellular fluid volume, translocation of sodium into a "third space") must be present for symptomatic hyponatremia to develop. The avoidance of overhydration would appear to be the only certain way that susceptible individuals can prevent symptomatic hyponatremia. Sodium chloride containing solutions ingested in physiologically significant concentrations would likely prevent a possible "third space" effect.A belief widely propagated in the scientific literature is that fluid losses during prolonged exercise are large and that progressive dehydration is an inevitable consequence (2,3,5,(34)(35)(36)(38)(39)(40)48,54,78,79,87,95,101,102). Indeed some authors have estimated that fluid losses can be as much as 4 1 per hour during exercise in the heat (5,43,79). Since maximum sustainable rates of fluid delivery to the intestine even during exercise of short duration are of the order of only 1 to 2 1 per hour (60), it follows that even if maximum rates of intestinal water absorption can match such high rates of fluid ingestion, progressive dehydration would be an inevitable consequence of prolonged exercise were such high sweat rates maintained.Progressive dehydration is believed to cause hyperthermia in proportion to the fluid deficit (39,43,101,102) and, when extreme, is considered to be the principal cause of the exercise-associated collapse that has become a common feature especially of ultradistance running and triathlon events (2, 36, 39,43,48, 66-68, 70, 78, 83, 85, 87, 91, 95). Therefore persons participating i n prolonged exercise have been encouraged to drink as much as possible to avoid these potentially serious complications, particularly heatstroke and other forms of heat Timothy D. Noakes is with the

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Collapsed Runners: Blood Biochemical Changes After IV Fluid Therapy

Cited by 14 publications

References 15 publications

Dysnatremia Predicts a Delayed Recovery in Collapsed Ultramarathon Runners

Dysnatremia Predicts a Delayed Recovery in Collapsed Ultramarathon Runners

Hyponatremia in Distance Runners

The Hyponatremia of Exercise

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