Monday, June 15, 2015

The ESPN headline writer must have been having a slow day. The reporter must have been under pressure to find a story, any story about Stephan Curry and the aftermath of the payoff game where he had starred. There can be no other explanation for:


Stephen Curry treated for dehydration, expected to play in Game 6

…After his postgame news conference, the league MVP appeared to be in discomfort as his father Dell Curry and Warriors security guard Ralph Walker ushered him to the locker room. Once there, Curry received drinking fluids to relieve the dehydration. Curry was watching SportsCenter highlights of the game while receiving treatment, according to the team…


Like construction workers, kitchen workers and many other people who physically labor in hot environments, the body needs enough water to cool itself and continue to function. Fall behind in the water balance, and there can be a vicious spiral that progresses through the states of heat related illness, heat cramps to heat exhaustion and finally to heat stroke.

The body can cool itself in many ways, but sweating is the most efficient. When sweat evaporates, it efficiently cools the body and for that to happen a few things need to be in place. First, the body needs to have enough water to generate sweat, there needs to be air movement so that the sweat can be swept of the body and finally, the surrounding air needs to have room to accept that evaporation. If the air is fully saturated with water, (the humidity is 100%) then there is no place for sweat to go and the ability for the body to cool itself is severely compromised.

The body generates heat routinely as it performs its basic functions including breathing, digesting food and general movement and activity. The amount of heat generated by strenuous exercise or work can increase tenfold and the body can react by sweating up to a liter an hour, more than 2 pounds of water, to help with cooling. The cooling potential gets more efficient as a person gets acclimated to a hot environment and after a few days of working or training in the hot sun, the amount of sweat that the body can generated may increase to 2 or 3 liters per hour.

The body can adapt to adversity but it may be hard to drink enough fluids to keep up with that lost with sweat. The body lives in a very narrow range of normal and should it become dry, the ability to function can deteriorate quickly. Heat cramps are the first stage of heat related illness and it is often the large muscles that go into spasm. Sometimes though, the body skips this stage and goes straight to heat exhaustion. There is excessive sweating, lightheadedness, nausea and vomiting. The key to treatment for both these situations is to stop the activity, get away from the hot environment and replenish the fluid that has been lost.

If the signs of heat exhaustion are ignored, not recognized or not treated, the body can get worse very quickly. Heat stroke describes the situation where organs in the body start to shut down and that includes the brain. The body stops sweating,  temperature spikes out of control, blood pressure drops and there is change in the mental status. The person may be lethargic, unconscious or seizures may occur. Heat stroke is a life-threatening emergency and even with emergency care, death is a distinct possibility.

Back to Mr. Curry. It is hard to get excited about a player being treated for dehydration by drinking water or Gatorade while watching television, but the concept of rest and rehydration in a cool environment is most appropriate. The good news is that he did not have to return to play again that day. The same treatment plan works for roofers, foundry workers and high school football players. Too often, people feel the need to return too quickly to the environment that caused their illness, without enough time for the body to recover.

Perhaps the easiest way to know that the body is on the road to recovery is that the kidneys are making urine. Specialized cells within the artery walls of the kidney decipher the body’s water status and a complex hormone system decides whether it is appropriate to make urine to get rid of the body’s waste material, or whether that water is too precious to lose. Conserving water means making very concentrated, very yellow, very foul smelling urine. Drink enough fluid, the kidneys get happy and the urine starts to flow again.

Regardless of the cause, the body needs adequate water intake to allow it to function. Prevention is key when living or working in a hot environment. Listening to the thirst mechanism and watching urine output are ways for monitoring how the fluid balance of the body is tilted. How important must this be? Most of us don’t have ESPN headlines telling us we just need to drink a little more water.



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Monday, December 15, 2014

How sick was Peyton Manning before taking the field on Sunday afternoon? According to ESPN, Manning needed to be rehydrated with 4 bags of fluid and that translates into being really, really sick. But sick is relative and he was able to take the field…but there should have been a disclaimer during player introductions, that a professional athlete’s body is trained to recover well from adversity and this behavior should not be tried at home.

Each bag of IV fluid contains one liter of usually normal saline, salt water or Ringers Lactate, a balanced salt and electrolyte solution and its purpose is to replenish lost body fluids. In patients who are ill, fluid can be lost in many ways, from excessive sweating to cool the body and control its temperature, to fluids lost from vomiting and diarrhea. If the patient cannot drink enough water or other fluids to replace the lost fluid, dehydration will quickly occur and bad things can happen.

The body’s fluid is located within blood vessels (intravascular: intra=within +vascular=blood vessel), within cells (intracellular) and in the interstitial space, the areas between cells. The blood in our arteries and veins is a combination of red blood cells, which carry oxygen, and the intravascular fluid. There needs to be enough blood volume with each heart beat to supply the body with its energy needs. As the body dehydrates and the amount of fluid in the body decreases, sensors in the kidney and brain start shifting fluid between the different spaces. The goal is always to supply the vital organs (brain, heart, lung, kidney, intestine) with oxygen rich blood to maintain their function. Fluid is shifted from the intracellular space, from every cell in the body, and from the interstitial space into the intravascular space, so that blood pressure and heart function can be maintained. This works reasonably well in the short term until the body can rehydrate and recuperate.

Dehydration happens routinely during illness but when the body gets really dry, a downward spiral can quickly occur. Without enough blood flow to supply adequate water, glucose and oxygen for aerobic metabolism, cells switch to anaerobic metabolism, a mechanism that is doomed to failure. Byproducts of that metabolism alters the body’s acid base balance to the point where the lungs and kidneys fail to monitor and adjust the pH of the body. Soon cells stop working. If enough cells fail, then a whole organ can fail and if enough organs fail then the whole body is in peril. This is the definition of shock.

Peyton Manning’s statistics list him at 6’5” and 230 lb. Based on his 4 bags of IV fluids, he was almost 5 % dehydrated. Fortunately, with good kidney function that adjust electrolyte concentrations within the intravascular and intracellular spaces, there was no need for his doctors to micromanage the fluid composition and could use stock IV fluid off the shelf. That’s not always the case for people at the extremes of age (infants and elderly) or for those who take diuretic and other medications that affect the sodium and potassium levels in the body. Goldilocks micromanaging becomes one of the arts of medicine so that not too much or too little of a particular electrolyte is provided.

It is a testament to the athletic ability of Peyton Manning to recover from that level of dehydration to take the field. Aside from the myalgia, the muscle soreness that accompanies a flu infection, his muscle cells were also inflamed from each donating fluid to the intravascular space. The adrenalin of the game can help recovery but it takes some mental strength to not listen to one’s body and force it onto the playing field.

The advice for most who suffer from the flu is to rest, drink plenty of fluids and then rest some more. One should listen to their body and the level activity should be as tolerated. Presumably, this advice does not necessarily apply to NFL quarterbacks.

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