Sensitivity and specificity of clinical signs for assessment of dehydration in endurance athletes

Abstract

The 5 parameters (decreased skin turgor, sensation of thirst, sunken eyes, inability to spit and dry mucous membranes) tested in this study did not precisely identify runners with total weight loss >3% at the end of a marathon.

Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete

“…The clinical diagnosis of dehydration is problematic, because these symptoms can occur with other medical illnesses. 43 Most cases respond to oral rehydration. Intravenous hydration should be considered in athletes who are not able to tolerate oral fluid intake and have evidence of significant hypovolemia (eg, orthostatis or resting tachycardia).…”

“…Studies of marathon runners have noted that 3% to 28% of runners experience some form of hyponatremia. [43][44][45] Studies of ultramarathon runners vary from an incidence of 5% to 50% for continuous singlestage 7,46 events to 1% to 12% for multistage events. 47 Although most EAH is often an asymptomatic biochemical diagnosis, there have been 12 documented fatalities.…”

“…If point-of-care testing is not available Injury and Illness in the Ultramarathon Athlete or unfeasible (ie, remote locations with extreme temperatures outside the capabilities of the point-of-care equipment), the physician should proceed cautiously with rehydration, considering their clinical assessment of the cardiovascular/emergent needs of the athlete, and potential risk of exacerbating EAH. [43][44][45][46][47] Epidemiology EAH is defined as a serum sodium concentration of less than 135 mmol/L that occurs during or up to 24 hours after prolonged exercise. 6 Most runners who experience EAH are asymptomatic, although a smaller subset experience symptoms potentially leading to significant morbidity or even death.…”

Water and Minerals in the Treatment of Dryness

“…The skin should be pinched and lifted to create a fold over the sternum, the abdomen, or the arm. In cases of decreased skin turgor, the skin fold will "hold" or "tent" for up to 30 s, whereas in normal conditions, it returns immediately to its original state [4][5][6] . Does the fact that severe dehydration can decrease skin turgor indicate that excessive fl uid intake in otherwise healthy individuals over a long period of time will do the opposite, namely, increase turgor?…”

Commentary: role of hydration in health and exercise

“…7 Clinical signs of dehydration are unreliable in detecting substantial fluid loss in athletes completing endurance events. 8 Athletes who finish exercise with thirst are mildly dehydrated and need to eat and drink in order to replace their solute and fluid deficits. 1 Athletes who complete exercise without thirst do not need any specific treatment.…”