Hyponatremia?

[Cherylbug]

I understand what Hyponatremia is but how do you get it? Is it really possible to get it while doing any type of endurance event? The reason I ask is because I don't see how you can have too much water in your body if you're sweating so much.:confused3 The cups of water/gatorade they give you during your race isn't really that much, right?? Is this more for people who carry their own water during the race? Is it more of a losing salt thing?? Sorry for all the questions but I was just curious and I knew you guys would have the answers.:thumbsup2

[wtpclc]

It's a combination thing. NSAIDs have been known to contribute, so taking ibuprofen or aleve before adn fro 2 days after a race is not recommended. t is also more of a salt thing. If you drink all water and do not take in electrolytes, you are more apt to get hyponatremia.

I know there is more in depth info, but basically balance yout powerade and water adn avoid the NSAIDs. Yes, it could happen durign any long endurance event.

[JimB.]

Hyponatermia = B A D

It is when your electrolytes get very diluted and the sodium levels in your body reach a critically low level. It can be fatal & is a life threatening emergency. I don't know the nuts-&-bolts medical process, but it can be caused by ingesting TOO MUCH fluids in an endurance event. But the good thing is, it's actually pretty hard to get. You will not get it by drinking water t every water stop, unless you drink about a quart a mile.

From an article I recently read, drinking gatorade, etc. won't prevent it if you are ingesting too much fluid. You do not want to gain weight from fluid intake during a race. The study I read actually said losing 1-2% body weight through sweating was preferable throughout a race. You are getting enough fluids to prevent dehydration, but not too much to possibly begin the onset of electrolyte problems.

I know other folks can fill in the blanks better than I, but that's what little I know. If you are healthy & not going crazy chugging water all the time, you should be ok.


avoid the NSAIDs.

But Advil is ok.......................

[escape]

But Advil is ok.......................

Advil is an ibuprofen....to be avoided, I thought. ??? I've heard Tylenol is ok, though.

[wtpclc]

Advil is an ibuprofen....to be avoided, I thought. ??? I've heard Tylenol is ok, though.

That's what I thought too. Although, I went through my 20-miler in 05 with Advil before I knew better. You have more scoop on that Jim? I'd much rather have my Advil.

[ultramickeymouse]

You can start the process even before the race. Common mistake is to drink too much water the few days before the race. You can start getting the imbalance than and once you start the race you make it worse.

It is like dehradtion, there are different levels(extremes).

Here is an example:

Some possible signs of sodium deficit in an race (note that many of these are aggravated by over-consumption of fluids):

1) Moderate deficit.
Sloshing of fluid in the stomach (fluid cannot be absorbed if there is a sodium deficit).
Swelling and tightness of the hands and feet.
Nausea or vomiting.

2) More serious deficit.
Cramps or muscle spasms.
Light-headedness and dizziness.
Headache.
Cravings for salty foods.

3) Very serious deficit – medical emergency.
Mental confusion or unusual behavior.
Seizures.

Some possible signs of excess sodium in an race:
Salty foods taste bad.
Strong thirst.

[AmyBeth68]

Ok...I definitely know the signs and risks...Scott and I are trying to figure out what the right combo is. Can you use a combination of gels and endurolyte type capsules? Or would you only use one or the other?

My issue is that gels work great for me, in terms of keeping my electrolytes in check (no cramping, no headache, no dizziness). Unfortunately, my sensitive stomach starts to rebel after 2 gels in a longer race. That is why I'm curious about the endurolyte products. I can't really take enough gels without it causing stomach distress. Solve one problem at the expense of another. :confused3

Robert...or anybody who uses endurolytes...can you tell me what combination and how frequently you use them? Looking at the capsules it seems they are similar in content to the power gels (which I use). But contain overall less per tablet.

TIA!

[ultramickeymouse]

Ok...I definitely know the signs and risks...Scott and I are trying to figure out what the right combo is. Can you use a combination of gels and endurolyte type capsules? Or would you only use one or the other?

My issue is that gels work great for me, in terms of keeping my electrolytes in check (no cramping, no headache, no dizziness). Unfortunately, my sensitive stomach starts to rebel after 2 gels in a longer race. That is why I'm curious about the endurolyte products. I can't really take enough gels without it causing stomach distress. Solve one problem at the expense of another. :confused3

Robert...or anybody who uses endurolytes...can you tell me what combination and how frequently you use them? Looking at the capsules it seems they are similar in content to the power gels (which I use). But contain overall less per tablet.

TIA!

I follow these instructions:

Use during the race:

Individuals vary in their electrolyte needs. Therefore only general guidelines can be given for electrolyte intake. Runners should determine their typical electrolyte needs in training.

Typical use rates for Caps are as follows:

In cold or cool conditions, one electrolyte cap per 2 hours.

In moderate temperatures and humidity, one electrolyte cap per hour.

In very hot temperatures where the runner is sweating heavily, one electrolyte cap per half hour.

Runners should not exceed 2 electrolyte caps per hour. Runners on a low sodium diet may be satisfied with fewer electrolyte caps per hour

[Cherylbug]

Thanks for the quick replies. I was just wondering because I seem to stay pretty thirsty during a race & sometimes during training. At races I usually take one cup of water and one cup of gatorade/powerade at each water stop. But sometimes I rotate them....1 cup of water at the first stop and then 1 cup of gator/powerade at the next stop and so on. I guess that's working for me so far so I'll just keep that up. I just want to make sure I'm not hurting myself by doing that. What do you guys take for pain if you don't use Advil? Just Tylenol? I have MAJOR IT band issues so I have to take something. Tylenol just doesn't seem to be strong enough to help me.

[ScoJo15]

I follow these instructions:

Use during the race:

Individuals vary in their electrolyte needs. Therefore only general guidelines can be given for electrolyte intake. Runners should determine their typical electrolyte needs in training.

Typical use rates for Caps are as follows:

In cold or cool conditions, one electrolyte cap per 2 hours.

In moderate temperatures and humidity, one electrolyte cap per hour.

In very hot temperatures where the runner is sweating heavily, one electrolyte cap per half hour.

Runners should not exceed 2 electrolyte caps per hour. Runners on a low sodium diet may be satisfied with fewer electrolyte caps per hour

Thanks Robert

I'm assuming that if one decides go to the electrolyte cap route, that would take the place of gels, correct??

What is the difference between the caps and the gels? I didn't see that much when I compared the packages...

thank you!

[wtpclc]

Cheryl - Have you tried Tyleol 8-hour?

Amy - I have Lava salts which ar ejust salt in a capsule, tehy help in exterme conditions. Did you see teh little sheets of electrolytes taht melt on your tongue at teh expo? I have a asample at home. I'll have to look up the name.

[Cherylbug]

Carrie--I have taken Tylenol-8 hour but it doesn't help that much. My doc gave me some Celebrex that I took the night before my last half marathon ('07 at WDW) and the night of the half and it helped more than anything I've taken so far. But even with that the pain was still there. I'm scared to try too much stuff because I don't know what it's going to do to my body and how it's going to mess with my hydration.

With that being said does taking Advil/Tylenol (or anything in those categories) mess up your electrolyes? Will they make you feel thirstier (if that's even a word) than you really are? Do they make you feel not so thirsty so you don't drink as much as you need?

[wtpclc]

I'm not sure that they know exactly why NSAIDs cause hypo., just that they have been involved in cases they have seen. :confused3 That's teh latest I've heard but something may have changed. It's a chemistry thing, so I'm not sure what happens and don't think docs have all teh answers yet.

[JimB.]

Whoops!!

Got it backwards. Sorry.

Tylenol is ok to take (acetaminophen), not ibuprofen.

And actually, in 99.9% of the people, ibuprofen is also, but why take chances....?

In your program for the WDW Marathon, it recommends that you do not take ibuprofen within 48 hours of race start.

When I play bike medic, I actually carry (lots of) Tylenol with me. I could probably sell it for a profit, but "drug pusher" is not in the job description..... :rotfl: :rotfl:

[escape]

I actually took some Advil the night before the marathon for the tendonitis in my left foot. :rolleyes1

Carrie - Kareneast had those little electrolyte sheets that we got at the expo with her on the day of the marathon. I took two of those (at different times) and I really think they helped. Actually, you don't put them on your tongue - you put them on the side of your mouth - something about them being able to absorb in your blood stream faster.

Cheryl - xterratri, Lynn, gave us a thorough explanation of all of this last year. I'll see if I can dig up her post as I couldn't begin to explain in detail the way she can/did. ;)

[escape]

I found the post from Lynne, xterratri -

"Hyponatremia 101- For you engineer types, the body works by way of electrical potentials across cell membranes that function kind of like those salt water batteries you made in chemistry class. The important positive electrolytes are sodium and potassium and chloride is the most important negative electrolyte. So basically salt(NaCl) and particularly the sodium is very important to all body processes. The body generally does a very good job regulating it's quantities but...
hyponatremia is the overdilution of the salts in your body. Barring a pathological process such as cancerous production of certain hormones, it happens by ingesting too much fluids and not enough electrolytes. It is really an act of overdrinking, particularly plain water. Hence the importance of gatorade/powerade etc in long events. In addition, salt is better absorbed through the intestine when paired with some glucose. What seems to have happened in some people is that they kept pounding the water past the point of need over-riding the bodies' signals and diluted their body fluids. This unfortunately can lead to BAD effects with fluid in the brain and people die from hyponatremia. Unfortunately the process behind the development of hyponatremia isn't fully understood and there seems to be more to it than just over-drinking of particularly plain water. There has been an association w/ NSAID use and that is why Tylenol is given out at the bigger races since its mechanism of action is different. There has also been an association with lower levels of training for the event and slower finish times.

So what to do to protect yourself? Develop a taste for one of the electrolyte drinks, don't consume massive quantities of fluid just because you think you should(16-24 oz/hr tends to be the recommendation), and unfortunately probably try and avoid NSAID pain killers on race day. Realistically, people take NSAIDs before and during races all the time so...

This public service message brought to you by the American Medical Athletic Association and their 2005 pre-Marine Corps Marathon CME meeting."

I tend to fall in the category of "slower finish times" so this was a concern for me.

[Cherylbug]

Susie--Thanks for digging that up. I tend to fall in the "slower" category as well but I was just curious because I do stay thirsty during a race. I think the majority of that is mental for me and not so much as my body being dehydrated.

[10nis]

Here is more info on the subject!

Robert and AmyBeth, how much sodium is in the endurolyte type capsules??

I did read in several research studies that NSAIDs can contribute to Hyponatremia during endurance events. It relates to altered renal function.


This article includes research studies done on the subject:
http://www.todaysdietitian.com/newarchives/archives/td_1005p14.shtml

It includes this on sweat weight (which I have seen in running magazines as well):

Determining Sweat Rate
• Weigh before and one hour after exercise.

• Subtract the postworkout weight from the preworkout weight.

• Then, add in the amount of fluid consumed during the workout—this is the hourly sweat rate.

A loss of 1 pound of body weight is equivalent to 16 ounces (480 milliliters) of fluid. The athlete should follow a fluid replacement schedule based on the hourly amount of fluid lost during exercise.

"For example, an athlete who lost 1 pound after an hour-long run and drank 16 ounces during the run has an hourly sweat rate of 32 ounces. The athlete should drink roughly 8 ounces (240 milliliters) or one-half of a 16-ounce water bottle every 15 minutes."

"The Inter-Association Task Force on Exertional Heat Illnesses Consensus Statement recommends that athletes be aware of individual fluid needs to protect against both hyponatremia and dehydration. The bottom line is that drinking too much or too little fluid can be dangerous."



THe below info came from this website, which has great information, even though it is dated--10 years old.
http://www.rice.edu/~jenky/sports/salt.html


Recommendations
There are no clear cut guidelines, and recommendations need to be individualized for each athlete.

Relative importance for different length races
less than 1 hour: water -/+, carbohydrate -, salt -
1-3 hours: water +, carbohydrate +, salt -/+
greater than 3 hours: water +, carbohydrate +, salt +


It cannot be stressed enough that you have got to know what your needs are prior to race day. Rehearse your hydration, feeding, and salt strategy during your training sessions. There are so many variations between individuals that there is no single right answer. Know what your body's' needs are.

Avoid aspirin, ibuprofen, or other anti-inflammatories, and acetaminophen during exercise, but especially during a race.
Check with your doctor if you have any health problems.

What about salt tablets?
It is best if you strive to get your sodium from both sports drinks and salty foods -- as opposed to salt tablets -- for two reasons. Salty foods stimulate thirst, and it is possible to ingest too much salt with tablets but very difficult with food. If you don't think that your food and sports drink is providing enough sodium, then consider salt tablets. Make sure you know how much you are taking!

What foods are best?
Ideally, foods consumed during a long race should be low fat, low protein, high carbohydrate, and provide a source of sodium. You need water, carbohydrates, and salt to survive a long race. For convenience, I have listed a few foods and sports drinks and their respective sodium content. You'll need to experiment and find the combination that is best for you. Get used to reading the FDA labels.

mg sodium serving fat(g) carbo(g)
protein(g)
Gatorade 110 8 fl.oz 0 14 0
Exceed 50 8 fl. oz 0 17 0

Baked Tostitos 140 1 oz.(13 chips) 1 24 3
SnackWell's
Wheat crackers 170 5 crackers 0 12 2
Sunshine Bavarian
Sourdough pretzels 490 2 pretzels 0 23 3
Baked Rold Gold
pretzels 500 10 pretzels 1 22 3
Baked Rold Gold
Hard Sourdough
pretzels 220 1 pretzel 0 19 2
Premium Fat-free
Saltines 130 5 crackers 0 11 1
Mr. Salty
pretzel twists 550 9 pretzels 0.5 24 333

[Tiger Lily 03]

I used endurolytes this last WDW event weekend. I am so glad I did. I felt much better than if I just used the beverages offered alone.

I must say thank you Robert for introducing me to these.

[mogulskr]

Thanks Robert

I'm assuming that if one decides go to the electrolyte cap route, that would take the place of gels, correct??

What is the difference between the caps and the gels? I didn't see that much when I compared the packages...

thank you!

I'm not Robert, but do use Endurolytes in a lot of my events. For an example in a 12 hour mountain bike race. My use of Endurolytes and gels will go like this. I wiegh anywhere from 168 - 175 depending when the events is.

Night before - 2 Endurolytes and I drink water, but no more then a normal day.

Just before the start - I will take 2 to 3 endurolytes depending on the temp and humidity. Plus a gel ( I use hammer gel).

Every hour I will take 1 or 2 endurolytes once again depending on the weather and a gel. I will drink between 16 to 20 ounces of water your body can not absorb a whole lot more per hour.

I will eat a little solid food every 2 hours, but not much. For me it is usually a 1/2 of PB and Honey sandwich.

As the race goes on I will adjust the Edurolytes depending on how hot and humid it is. No matter what I will not skip one. I have cramped up before so bad I fell off my bike. I can also read my body much better now then when I first started these types of events so that helps.

Hope that helps a little.

[scoolover]

I guess that it's good to know that this exists but I have a hard time buying the whole concept. Dying because your water is too diluted. :confused3 How many people have died because of this? It's not enough to really make me concerned. Like I said though. It's nice to have the info just in case.

[ultramickeymouse]

I guess that it's good to know that this exists but I have a hard time buying the whole concept. Dying because your water is too diluted. :confused3 How many people have died because of this? It's not enough to really make me concerned. Like I said though. It's nice to have the info just in case.

This is a head in sand approach. The chance of dying from this is very small. Usually during most major marathons, 1 person will die from it. At the London Marathon, a personal trainier who was in his late 20's died.

The more important lesson is to watch for the slight to moderate symptoms. These can just effect your performance to cause you to drop in the race. I heard from many WISH'ers would seemed to show these symptoms. I also know a couple of WISH'ers who had to drop. If they didn't they would have probably entered the next phase of being hospitalized.

If this wasn't a concern, all marathons(including Disney) wouldn't post warnings. This condition was mis diagnosed as dehrdration and only now getting full press.

I am a Ultramarathon Race Diretor and I worry about people not taking care of themselves. I don't want anyone to die at my races.

[scoolover]

Robert

Like I said, it is good to be aware that it can happen. It is something to keep in the back of your mind as a possibility but so is freak lightning on a georgous day. It can happen but is not very common. Why don't we hear more about the many deaths due to this? I have heard about two. I have never professed to know much about it but I just don't see it as a "major" problem.

[scoolover]

After further research, I stand corrected.

http://www.womenrunners.com/training_hyponatremia.htm

http://content.nejm.org/cgi/content/short/352/15/1550

My stance is that one should not, not drink at the expence of getting hyponatremia.

[ultramickeymouse]

Robert

Like I said, it is good to be aware that it can happen. It is something to keep in the back of your mind as a possibility but so is freak lightning on a georgous day. It can happen but is not very common. Why don't we hear more about the many deaths due to this? I have heard about two. I have never professed to know much about it but I just don't see it as a "major" problem.

I again that the death possibility is not what the focus should be on. I agree if you are only worried about dying from it, I would tell everyone to drop this topic.

As mentioned, the fact the is getting lost is that hyponatremia doesn't only equal death. It's like saying only dehrydration equals death so we shouldn't worry about it either.

Both of these conditions occur 1000's of time at WDW in Jan. All on different levels. The lower levels effect performance. Isn't that something everyone should be concerned about? If you have to go slower or don't feel great, doesn't that matter?

At moderate levels, if it causes you to be light headed, sick to your stomach, and prevent you from finishing a race. Isn't this a concern for EVERYONE?

Yes, you have a greater chance of dying in a car accident. What we need to understand if we want to have a good race, finish strong, and finish, we have to learn of all the conditions that prevent this. We need to understand the symptoms and how to correct. This can be done on the fly during the race if we are prepared. If we don't care because it won't kill us, then go ahead and not prepare.

Hyponatremia happens all the time at races(not like a lightening strike), it just how bad it hits you. Death is rare but that isn't the only concern!

[bunnyfoo]

I remember last year there was a story in the news about a woman who was participating in a contest for a Wii and she died from drinking too much water. I guess it can happen even outside of a running/race situation.

[scoolover]

I again that the death possibility is not what the focus should be on. I agree if you are only worried about dying from it, I would tell everyone to drop this topic.

As mentioned, the fact the is getting lost is that hyponatremia doesn't only equal death. It's like saying only dehrydration equals death so we shouldn't worry about it either.

Both of these conditions occur 1000's of time at WDW in Jan. All on different levels. The lower levels effect performance. Isn't that something everyone should be concerned about? If you have to go slower or don't feel great, doesn't that matter?

At moderate levels, if it causes you to be light headed, sick to your stomach, and prevent you from finishing a race. Isn't this a concern for EVERYONE?

Yes, you have a greater chance of dying in a car accident. What we need to understand if we want to have a good race, finish strong, and finish, we have to learn of all the conditions that prevent this. We need to understand the symptoms and how to correct. This can be done on the fly during the race if we are prepared. If we don't care because it won't kill us, then go ahead and not prepare.

Hyponatremia happens all the time at races(not like a lightening strike), it just how bad it hits you. Death is rare but that isn't the only concern!

Well said and I agree after becomming more aware of the issue.

[WDWFAN9]

At moderate levels, if it causes you to be light headed, sick to your stomach, and prevent you from finishing a race. Isn't this a concern for EVERYONE?



Hey, I resemble that remark!

I didn't think I was drinking that much during the Jan full, but these were my exact symptoms. I'm sure it didn't help that the salt packet I grabbed at the food court turned out to be sugar. When I noticed that I was starting to weave as I walked I made the difficult decision to pull myself out at the AK. Fortunately the ill effects didn't last long, but it sure was scary!

[ultramickeymouse]

The other siide from what Pat mentioned is that it isn't only caused by drinking too much. It is an electroylte imbalance issue. I drank one or 2 cups of water at every aid station but took 1-2 endroyltes pills every hr. This imbalance can be caused before you even start the race and can be pushed along during the race.

Everyone is an experiment of one. These are guidelines and things to learn about and help you through the next race. To be homest. I did many, mnay ultras with taking endrolytes and always had problems in hot races. I would get sick and sloshy stomach. A friend turned me on and my last few ultras I ever did in 2001 really helped. After becoming an RD, I really tried to learn more. I have captained aid stations for many 100 milers where I am responsble for keeping runners going and if having medical issues help treat or have them removed by RD. We never want a runner to die.

A side story at Western States 100, a firend of ours came in totally out of it at mile 98. He was brought in on horseback. He had glazed eyes and had no idea who or what was going on. Four days later he had to go to the hospital and had 7 bouts of dialises. He has never been the same and can't do ultras do to the damage caused. He didn't die but his life and body will never be the same.

Pat did a smart thing as the last thing she would want is to spend the rest of her trip in the hospital.

Knowledge is a tool that you can do whatever you want with. Everyone train and race smart.

I want to see all of you at WDW in Jan:thumbsup2

[wtpclc]

The otehr thing to keep in mind is that these can also be dehydration issues. :guilty: Too confusing. Still, if you recognize these symptoms it's time to calll it quits and seek help.