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Family in disbelief that drinking too much water killed football player

Posted on Saturday, September 13, 2008 at 03:31PM by Registered CommenterVance Alford | Comments Off
 Xooma Team,
 
I would like to share a tragic story with you about a young athlete in our city who died from Hyponatremia.  I have included the story, along with an article about hyponatremia, which is basically caused when an athlete loses electrolytes through sweat and hydrates with water that does not contain enough electrolytes.
 
It is very sad to think that this tragedy might have been avoided if this team had hydrated with water containing Xtreme X2O!  We have the awesome responsibility to share with our families and friends, the importance of hydrating with water that alkalizes and mineralizes the body.
 
Thanks and God bless,
Doug Kurfess
 

Family in disbelief that drinking too much water killed football player

Patrick Allen
 
“What do you do when you have cramps?” he said. “You drink lots of water and rehydrate.”
Patrick Allen — a 17-year-old Bakersfield Christian High School student, who had been practicing in the heat hours before collapsing — died of complications from an electrolyte imbalance, the Kern County coroner’s office said after examining medical records and conducting toxicology tests.
The main complication was hyponatremia, an imbalance caused by drinking too much water during physical exercise and losing too much salt through sweat, said supervising deputy coroner John Van Rensselaer.
Salt is an electrolyte that retains water in the bloodstream, he said.
The coroner’s office did not find any pre-existing conditions, medications or other factors that contributed to Allen’s death, Van Rensselaer said.
Symptoms of hyponatremia include cramping, lightheadedness, vomiting, nausea, fatigue, headaches, weakness, abnormal mental state and swelling of the hands and feet.
“When there is a large quantity of water, it breaks down the red cells, and those red cells contain a huge amount of potassium,” said Dr. T. Anthony Don Michael, founder of the Bakersfield-based Advanced Heart and Medical Center and cardiology professor at UCLA.

“That can actual cause the heart to stop.”

Robert Allen said his family did not know the signs of hyponatremia, and so they had no idea that Patrick suffered from the condition.
“You think you are doing everything right and then this still happens,” he said.

Bakersfield Christian officials declined to comment because they had not seen the coroner’s report.
When Allen returned home from practice Aug. 14, he complained of leg cramps. He drank water and Gatorade to hydrate, Robert Allen said. His parents called an ambulance after he vomited.

At the hospital the next day, he had fluid in the lungs and surgery to relieve pressure on his brain, which are consistent with hyponatremia, Van Rensselaer said. Patrick died Aug. 16.

Don Michael said hyponatremia is uncommon.

In the 16 years that Mike Medeiros, with Terrio Therapy Fitness, has been in the field, he’s never come across a case.

“It’s a little odd,” said Medeiros, manager of athletic training services. “It’s rare, but it happens.”

Athletes should not avoid hydrating out of fear of the condition, said Darin Siebert, a doctor of physical therapy with Bakersfield Sports Medicine and Rehabilitative Therapy.
“That would be madness,” he said.

Instead, athletes under intense physical stress should drink fluids that contain electrolytes, like Gatorade, or take salt pills, Don Michael said.
Allen’s parents are somewhat relieved to hear Patrick’s death was not genetic because they worried about their oldest son, Michael, and any future grandchildren.

But Robert Allen also said they are still dealing with their son’s tragic death.

“Hopefully, we will learn something from this, so no other family has to go through this,” he said.

Local experts offered these suggestions for avoiding hyponatremia:
• Drink fluids with electrolytes, like Gatorade, or take salt pills with water during heavy exercise.
• Avoid sugary sports drinks.
• Athletes should gradually become acclimated to the heat. This could mean working up to practicing in full pads, which constrict the body’s ability to cool down.
Acclimating can take two weeks, according to the National Athletic Trainers’ Association.
• Athletes should be in shape at the first practice.
“When your kids are showing up to practice, they should not be showing up to get fit,” said Darin Siebert, a doctor of physical therapy with Bakersfield Sports Medicine and Rehabilitative Therapy. “They’re showing up for skill acquisition.”
 

Salt and the ultraendurance athlete

Recently, Americans have been urged to pay more attention to their sodium intake. Decades ago, all foods seemed heavily salted. Then, a link between sodium intake and high blood pressure was discovered. Suddenly, "sodium - free" or "low sodium" products began flooding the consumer market. Certainly, to a degree, this is justified. Many diseases are worsened by excess sodium intake, and millions of Americans must closely watch the amount of sodium in their diet.
However, sodium is a required element for normal body functions. It is lost in sweat and urine and is replaced in the diet. The body has a remarkable ability to maintain sodium and water balance throughout a variety of conditions, thus ensuring our survival. Ultraendurance events challenge this survival mechanism.
In hot, humid conditions a large amount of sweat is lost, which can disturb sodium and water balance. Adequate hydration and sodium intake -- either via sports drinks or food -- becomes vitally important during long races. The goal of this article is to help you determine how to maintain sodium balance during training and racing and during recovery. The information for this article came from a variety of published studies done on healthy, young athletes and may not be appropriate for everyone. Athletes who are under a physician's care or have health problems should check with their doctor about salt and their ability to exercise in the heat.
 

Hyponatremia -- what is it?

Hyponatremia means a low concentration of sodium in the blood. When it occurs in triathletes, it usually happens during long or ultra-distance races in the heat but may occur anytime. It is estimated that approximately 30% of the finishers of the Hawaii Ironman are both hyponatremic and dehydrated. The longer the race, the greater the risk of hyponatremia.
 

What causes it?

The exact mechanisms are not fully understood and I won't go into the complex physiologic pathways of sodium and water balance. The simplest answer is that lost sweat (salt and water) is replaced by ingested water (no salt). This dilutes the sodium in the bloodstream, and hyponatremia results. Longer races carry a greater risk of hyponatremia because of the total amount of sweat lost. During exercise in the heat, more salt is lost in sweat per hour than is usually replaced by food and fluids, including sports drinks. Your body can tolerate a degree of imbalance for a short period of time, but it may decompensate if this continues for too long.
Sweat contains between 2.25 - 3.4 grams of salt per liter, and the rate of perspiration in a long, hot race can easily average 1 liter per hour. So, for a 12 hour race, one could lose approximately 27 to 41 grams of salt. If the athlete replaces only the lost water and has minimal salt intake, hyponatremia can result.
 

Medications and hyponatremia

Aspirin, ibuprofen, and other non-steroidal anti-inflammatory agents interfere with kidney function and may contribute to the development of hyponatremia in triathletes. The same applies to acetaminophen (Tylenol). I have seen many athletes taking these drugs during Ironman races, and I strongly recommend against this practice. They won't make you faster and may hurt you. Under tough conditions, your kidneys need to function at 100%. Other drugs that may contribute to hyponatremia are diuretics, narcotics, and certain psychiatric medications.
 

What are the symptoms of hyponatremia?

The spectrum of symptoms can range from mild to severe and can include nausea, muscle cramps, disorientation, slurred speech, confusion, and inappropriate behavior. As it progresses, victims may experience seizures or coma, and death can occur. Severe hyponatremia is a true medical emergency.
 

Treatment

Minor symptoms, such as nausea and mild muscle cramps, can be treated by eating salty foods and hydrating with a sodium containing sports drink. More severe symptoms require treatment by qualified medical personnel. If you think you are suffering from hyponatremia or are unsure, seek medical attention immediately.
 

Recommendations

There are no clear cut guidelines, and recommendations need to be individualized for each triathlete. Some authorities recommend drinking less water to rebalance sodium and water intake. However, given the risk of dehydration and heat injury, this is not a practical recommendation. To reiterate, all of the hyponatremic athletes in the Hawaii Ironman were also dehydrated. Others recommend increasing salt intake, and this seems more prudent. By ingesting more sodium, hydration with water is balanced and dilution of blood sodium does not occur.
 

Relative importance for different length races

length of race
   less than 1 hr   1 - 3 hrs  >3 hrs
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.
  • Drink frequently to attempt to stay hydrated.
  • During a long, hot race, aim for a total sodium intake of approximately 1 gram per hour, as recommended by Doug Hiller, M.D. from experience with the Hawaii Ironman. Please note that this may not be appropriate for everyone.
  • During training, heat acclimatization, and for several days leading up to a big race make sure that you increase salt intake by 10 - 25 grams per day.
  • Sodium is also important for recovery. A Texas favorite after a hot training ride, or run, is low-fat tortilla chips (salty ones) and picante sauce (quite salty).
  • 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.
 

Salt vs. Sodium?

Undoubtedly, some of you have noticed that FDA food labels list grams (or milligrams) of sodium, and at times in this article, I have referred to grams of salt. What is the difference? Salt is made up of sodium and chloride. The FDA labels lists only the sodium content. This is because there are usually other sodium containing salts (eg. sodium citrate) in these products. To avoid confusion, the easiest way to ensure that you have enough sodium intake is to get used to reading the FDA labels. For example to get 1 gram (1000mg) of sodium into your body, you would need to drink more than half a gallon (2.18 liters) of Gatorade -- certainly impractical every hour! To get 1 gram of sodium from table salt, you would need to ingest 2.5 grams (1 gram from sodium, 1.5 grams from chloride). A teaspoon of salt weighs approximately 6.6 grams.
 

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
 
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