Dehydration: An Overview
Guest: Dr. David Geier – Orthopedic Surgery, MUSD
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. David Geier, who is Assistant Professor of Orthopedics and Director of MUSC Sports Medicine Clinic. Dr. Geier, let’s talk about some of the special problems that athletes have that are related to heat, which is important, I guess, in many areas of the country, certainly here in South Carolina. What are some of the problems that seek medical attention?
Dr. David Geier: Well, no question, it’s a problem in this area. You have a situation where people can play sports year-round, and it can get above 80 degrees eight or nine months of the year. And, certainly, we have six or seven months with heat indexes well over 100 degrees sometimes. You’re certainly at risk for heat stroke, and more minor concerns, such as dehydration, and medical problems that come with that. When we’re talking sports, this is a very active community. A lot of kids and young adults are out there pushing their bodies through really extreme temperatures.
Dr. Linda Austin: Well, let’s start, then, with simple dehydration, which is, I guess, fairly common. What are some of the symptoms of dehydration?
Dr. David Geier: The problem with dehydration is that once it’s happened, it’s too late. They key is to try to prevent it. The symptoms of dehydration include excessive thirst, or, in milder forms, sweating a lot. As it gets to be more severe, and you’ve lost a lot of body fluid, your body doesn’t have the capacity to sweat anymore, so you’re at risk for your core body temperature rising. Again, the key is not so much treatment, but much more on the prevention side.
Dr. Linda Austin: What are some tips for the athlete?
Dr. David Geier: First and foremost, is to drink lots of water. I don’t necessarily mean 20 or 30 minutes before they go out, but, really, throughout the day, on a daily basis, drinking plenty of water; more than you’d expect. I think the athlete is always surprised how much water is required to stay ahead of the curve, as far as water loss goes. Drink plenty of water, or Gatorade; electrolyte mixes, whatever. You don’t ever want to feel thirsty. Once you’ve become thirsty, you’re behind in terms of fluid replacement. So, much more than anything else, eat lots of light fruits and vegetables; things that have a high water content and are easily digestible, and drink plenty fluids, and replace those fluids as you go. There are all kinds of different requirements, but try to stay ahead of things. You know, the more you sweat, the more fluids you need to take in.
Dr. Linda Austin: You mentioned Gatorade and other electrolyte balanced preparations. Are they important? Do they have an advantage over water, and when should you drink those?
Dr. David Geier: They do. It’s interesting. There’s a lot of scientific research about what the best formula is. And I don’t know that there’s any consensus. Clearly, water is, a lot of times, the easiest for an athlete to digest because it doesn’t have a lot of sugar, which can cause cramping, making if difficult to run on a stomach full of a sugary substance. Having said that, the electrolytes in a product like Gatorade, or SmartWater, and VitaminWater, are certainly beneficial. By sweating, not only are you losing fluid, you’re losing sodium and potassium as well. So they definitely have advantages. The question is trying to find the right balance.
Some people advocate mixing half Gatorade and half water to dilute it. Really, I don’t think there’s a consensus. I do think that it’s probably a little bit better than plain water, but I’m not sure that there’s a perfect formula for everyone. Everybody loses different amounts of electrolytes and needs different replacement products.
Dr. Linda Austin: I recall one time, my son, who was playing high school basketball, got so dehydrated that he started to get delirious once we got home. In a situation like that, is plain ole water adequate, or should one especially have electrolytes then?
Dr. David Geier: That’s a very touch situation. Again, you want to try to prevent it from getting to that point. I think most people, clearly, feel like drinking water, as opposed to pouring water on their head; a common misconception as to how you get your core body temperature down. To be fair, I think, in that situation, any type of fluid is beneficial. If you have a readily available Gatorade-type of product with some electrolytes; even something like Pedialyte, that you can get down, that’s certainly preferable. But in that type of situation, even water is adequate.
If you’re trying to get your core body temperature down very quickly, obviously, you’re going to drink the water. But there are probably more effective ways than what you see the kids on the field, or the runners, doing, which is pouring it on their head. Probably better ways to do that are to take icepacks and put them around your face, or under your armpit; areas where there’s a lot of heat evaporation.
Dr. Linda Austin: Is that what heat stoke is, core body temperature going too high?
Dr. David Geier: Yeah. There are different grades of heat illness. Heat illness is kind of the broad term for heat exhaustion, heat stroke. When you go beyond dehydration, your core body temperature starts to rise, and that’s when you can get some of the really serious side effects, like seizures, cardiopulmonary collapse, things like that. The potential morbidity, the risk of serious injury, if not death, is extremely high once you get to that point.
So again, I’m emphasizing prevention. Every year, in this country; it varies year to year, between five and ten high school football players die of heat stroke during summer practice. You have overweight kids, a lot of times, that haven’t been training throughout the summer, and they come in out of shape. They go out on the football field in heat indexes of 100+ degrees, three hours of practicing, and full pads. It does happen, unfortunately. And once they get to that point, there’s very little that EMS can do. Obviously, you take them to the emergency room with fluid resuscitation. But, again, the key is prevention.
Dr. Linda Austin: Do you have any recommendations to coaches, or even parents, about when the heat index is simply too high, and it’s just not a time to be having a football practice?
Dr. David Geier: Absolutely. Fortunately, many states, including South Carolina, have rules in place. When the heat index is above a certain level, you either can’t practice at all, if it’s truly above certain levels, or you have to transition your practices to certain times of the day. I’d recommend a couple of things. One is to practice, especially if you’re trying to run two practices a day, in the early morning, and one later in the evening; 6:00 to 8:00 in the morning, and a 6:00 to 8:00 at night, something along those lines. Do the best you can to catch the temperature at a time when it’s as low as possible.
Also, emphasize that kids need to show up in shape. Have them run throughout the summer on their own, lifting weights, so that they’re in the best possible shape when practice starts. Maybe, vary the routine so that some of the training is indoors, or in the weight room. Vary it up so that you’re not in the direct heat for two, three, hours straight.
Most states do have guidelines about absolute temperature and humidity for making judgements. The key becomes getting that information out from the school districts to the individual coaches, and then the coaches understanding the importance of it and actually abiding by the rules.
Dr. Linda Austin: One of the things I hear young boys talk about is working out so hard that they throw up, and seeing that as some sort of badge of honor, almost; that they haven’t had a good workout unless they’re throwing up. What causes that? And is that too much of a workout when you’re throwing up?
Dr. Linda Austin: It’s a combination of factors: working well past the proper level of hydration and fatigue, especially when some of these kids are out of shape. And then, a lot of times, they’re really pushing their bodies, getting dehydrated, and then drinking a lot of fluid all at once, and then they get sick to their stomach. It brings us back to the point of drinking enough fluids ahead of time; three, four, hours a head of time, so that it’s in your system, not just sitting, empty, in your stomach, where it comes right back up with heavy exertion.
Dr. Linda Austin: And then I guess you, throughout the game, sip continuously, as opposed to great big, hug amounts.
Dr. David Geier: Yes, especially in situations where there are athletic trainers that can get out to the sidelines to hand out water bottles continuously; making sure it’s available in multiple places along the sidelines. And then, yes, frequent and small amounts of fluid are certainly safer, and probably more easily tolerated than 8 or 10, or 12, ounces all at once, in the middle of competition.
Dr. Linda Austin: Dr. Geier, thanks so much for talking with us today.
Dr. David Geier: Thank you.
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