dehydration

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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