Intravenous Fluid Use in Athletes

Abstract

Context:Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently.Evidence Acquisition:PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance.Results:Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid.Conclusion:The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency–governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes.

National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active

“…Such IV fluids are rarely necessary in otherwise healthy patients. Outcomes after rapid IV rehydration suggest no lasting benefits exceeding those of oral rehydration, 218,248 and hormonal and fluid balances are facilitated by the oropharyngeal reflex and swallowing. 146,147,219,249 Oral fluids are recommended as the firstline rehydration strategy for most patients with exerciserelated hypohydration, although some recent evidence 146,147 suggests that recovery from hypohydration (approximately 4% body mass loss) is most efficient with the concomitant use of IV and oral fluids.…”

Commercialised portable intravenous fluids in sports: placing vulnerable athletes at risk

“…On the other hand, the potential risks from unregulated intravenous hydration of athletes include infection, ecchymosis, electrolyte imbalance, air embolus and needle sticks to the provider 5. It is particularly concerning that intravenous isotonic and hypotonic fluids can worsen mild or asymptomatic hypervolaemic hyponatraemia, causing rapid progression to seizure 9.…”

An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps

“…While intravenous fluids (IV) are popular amongst professional athletes, they require training in their administration and pose some risks (e.g., infection, air embolism, arterial punctures). 39 Numerous studies have examined oral versus IV fluid administration on hydration status and noted comparable restoration in plasma osmolality, plasma volume, skin blood flow, stroke volume, cardiac output, heart rate, skin temperature, rectal temperature, performance, and fluid regulatory hormone responses. 38,39 Interestingly, perceptual measures (e.g., thirst, thermal sensation, and rating of perceived exertion) are often lower with oral rehydration because IV fluid delivery bypasses fluid volume receptors in the mouth (i.e., baroreceptors).…”

“…39 Numerous studies have examined oral versus IV fluid administration on hydration status and noted comparable restoration in plasma osmolality, plasma volume, skin blood flow, stroke volume, cardiac output, heart rate, skin temperature, rectal temperature, performance, and fluid regulatory hormone responses. 38,39 Interestingly, perceptual measures (e.g., thirst, thermal sensation, and rating of perceived exertion) are often lower with oral rehydration because IV fluid delivery bypasses fluid volume receptors in the mouth (i.e., baroreceptors). 40 While either fluid delivery method can be used to treat EAMC, IV fluid administration should be saved for time-sensitive situations (i.e., <15 minutes) or situations where patients cannot orally consume fluids (e.g., too much pain, repeated vomiting).…”

“…Some clinicians use IV fluids to prevent EAMC and believe they are effective. 39 Unfortunately, no large scale clinical trials have demonstrated IV fluid administration reduces the occurrence of EAMC or shown it is more effective than oral fluid administration. 39 Since EAMC are non-life threatening and oral rehydration can safely restore fluid and electrolyte deficits, 38 we recommend clinicians avoid using IVs prophylactically.…”