Fluids and Rehydration: Our Biggest Problem in Swimming

1. Fluids and Rehydration: Our Biggest Problem in Swimming Jackie Berning, PhD, RD, CSSD Associate Professor/Chair University of Colorado at Colorado Springs Sports Dietitian: Denver Broncos, Colorado Rockies, Cleveland Indians jberning@uccs.edu

2. Fluids • 50-70% of body weight is fluid • Fluid serves to: • Dissolve and transport substances • Account for blood volume • Maintain body temperature • Protect and lubricate tissues

3. Electrolytes in Sweat • Primarily sodium and potassium • Electrolytes draw water toward areas where they are concentrated • Fluid balance is achieved by electrolytes • Sodium outside the cell (extracellular) • Potassium inside the cell (intracellular) • Food poisoning…diarrhea and vomiting causes fluid loss in the extracellular compartment, causes extracellular electrolytes to become concentrated and fluid flows from within the cell to outside of the cell causing irregular heart beat and eventually death.

4. Fluid Loss • Urine • Sweat • Exhalation • Feces • Fever, cough, vomiting, “D”, blood loss, exercise, high altitude, cold and hot temp, low humidity, pregnancy, breastfeeding, diuretics such as alcohol, caffeine

5. Fluid Needs • Institute of Medicine (IOM) Guidelines: • Did not recommend a specific amount of fluid but told consumers to use thirst as a way of determining fluid needs • Noted that about 80% of fluid needs come from the fluids we consume and 20% from food • Assuming this it would mean • 9 cups for women/day • 13 cups for men/day • Guidelines may be good for consumers, but not for athletes

6. Factors That Affect Fluid Intake • Heat • Humidity • Physical exertion • Acclimatization • Out of shape • Overweight

7. Sweat • Composition of Sweat • Water • Electrolytes • Sodium • Potassium • Chloride • Some athletes are profuse sweaters • Some athletes lose more electrolytes than others

8. Heat fit Athlete • Sweats earlier • Sweats heavier • Saves salt but, • Faster sweating=more salt loss • Hot games can sweat 1-2 gallons water and 2-5 tsp salt

9. Too Much, Too Little • Too Little • Dehydration—fluid loss causes, impaired physical and mental function and death • Too Much • Hyponatremia—dilute plasma sodium causes headaches confusion, seizures, coma and death

10. Dehydration • 3rd leading cause of death in HS athletes • 8 HS athletes died last year due to dehydration • Chicago marathon stopped early due to the heat and nearly 300 runners were hospitalized • Swimmers are at risk • Don’t see or feel sweat • Swim caps may increase the risk

11. Heat illness is in the headlines

12. Bechler's organs failed as result of heatstrokeFeb 17, 2003 FORT LAUDERDALE, Fla. -- Baltimore Orioles pitching prospect Steve Bechler died of heatstroke Monday, unable to recover from a spring training workout that sent his body temperature to 108 degrees. The environmental temperature at noon Sunday was 81 degrees and the humidity was 74 percent

13. High School Coach Indicted for Death of Athlete • Jan 2009, Kentucky HS football coach was indicted for death of an athlete • The coach had denied the athlete water during a hot August football practice. The player collapsed during a practice on August 20, 2008 and died three days later. • More than 20 minutes passed between the time Max Gilpin (15 y.o.) collapsed and the time one of the coaches called paramedics. • This case is being closely followed as it is the first case that a coach has been charged with the death of an athlete due to dehydration.

14. Denver jury awards $1.6M to heatstroke victim • A jury found Gold Crown Basketball Foundation responsible for heatstroke suffered by Joshua Fairbrother. • Fairbrother was 14 when he collapsed before halftime during a summer game at a high school in Denver. It was 83 degrees outside, the gym's air conditioning was not on, and no medical help was on hand • Fairbrother has suffered cognitive disabilities from complications from the heatstroke

15. Lessons Learned • DO NOT deny fluids during practice • Have a plan for emergency • Know the symptoms of heat exhaustion • PREVENTABLE • MUSCLE CRAMPS- usually hamstrings, gastroc during and after practice/games • HEAT EXHAUSTION- profuse sweating, increased body temp. confusion, nausea, disorientation, need to be transported to medical facility for IV fluids • HEAT STROKE- FATALno longer sweating, temp regulation shut down, deep red color, body temp >106 degrees MEDICAL EMERGENCY CALL 911

16. Hyponatremia • A condition in which body sodium is diluted due to over consumption water (water intoxication) • Who is at risk: endurance athletes, low sodium diets, salty sweaters, slower athletes • How to prevent: don’t over drink, maintain a salty diet, favor sports drinks, recognize warning signs • Rapid weight gain, swollen hands, confusion, fatigue, cramping, throbbing headache, bloated stomach • SEEK MEDICAL CARE

17. Sodium • Sweating decreases sodium but not potassium, calcium or magnesium • Sodium is essential for • Nerve signals • Muscle contraction • Maintenance of blood volume

18. Sodium • Needed for carbohydrate absorption • Water follows Carbs • Need to be at least 100 mg sodium • 28 grams potassium • No carbonation • Hyponatremia- loss/dilution of plasma sodium, severe cramping, potentially deadly

19. Salty Sweaters • Caked with salt after practice and games • Usually see a salt ring on jersey or hat • Sweat burns eyes; tastes salty • Not acclimatized • Increase in Muscle twitches • HX for Cystic fibrosis? • Previous whole body cramping

20. Hydration Options • Sports drinks with electrolytes will fend off muscle cramping • 110mg sodium/8ounces of fluids to fend off muscle cramping • Players with extreme cramping can add ¼ tsp salt to 16-20 oz beverage • GatorLYTES/Endurance Formula • Sports drinks with sodium maintain the drive to drink • Sports drink with electrolytes and 6% carbohydrate solution will help with hydration and provide energy for extended games and workouts

21. Practical Applications • Add additional salt to the athletes diet • Salted pretzels • Tomato juice/V8 juice • Chicken noodle soup • Cheese and salted crackers • Salted peanuts • Prepackaged rice and meals

22. Stories from the TrenchesWhole body Cramping • Immediate medical attention • Player may be out for the whole game • Due to dehydration, loss of sodium • IV at half time • decreased when using a 6% CHO sport drink • increased sodium in foods and drinks

23. Budweiser’s B to E • A beer for “young adults to keep up with their social and fast paced life” • 3.2% alcohol, raspberry flavored beer • Caffeine, Guarana, Ginseng • Combines an upper with a depressant • Concerns: • drink more, flavoring • Upper and depressant could lower heart rate, breathing • Alcohol poisoning

24. ADVOCARE SPARK Energy drink for kids From the New York Times, Sunday 9/26/05 “pediatricians, medical experts and others involved in youth sports express strong concern about the levels of caffeine and the idea of encouraging children to use performance-enhancing products, especially at a time when professional athletes are under scrutiny for using stimulants and muscle builders”

25. Thank You