One lawsuit, coming up. (http://www.cnn.com/2007/US/01/13/water.intox.ap/index.html)

"I was talking to her and she was a nice lady," Ybarra said. "She was telling me about her family and her three kids and how she was doing it for her kids."

Tragic really..

Tragic really..

Very tragic. They broke two rules:

1. Not voiding ... considering voiding is the body's main way of regulating water balance as well as flushing toxins, and

2. Providing water with no electrolytes.

The (2) is where I see most people fail. They start an exercise program and are big on staying hydrated, but there is that stigma over sports drinks like Gatorade ("loaded with sugar") etc. But the fact of the matter is that when you train, you sweat out a ton of sodium. Without replacing this, if you continue to hydrate, you create the condition of hyponatremia (http://en.wikipedia.org/wiki/Hyponatremia) - not good.

If you are super-hydrating, be sure to compensate with electrolytes. There are other solutions than Gatorade that have less sugar.

Jeremy

Very tragic. They broke two rules:

1. Not voiding ... considering voiding is the body's main way of regulating water balance as well as flushing toxins, and

2. Providing water with no electrolytes.

The (2) is where I see most people fail. They start an exercise program and are big on staying hydrated, but there is that stigma over sports drinks like Gatorade ("loaded with sugar") etc. But the fact of the matter is that when you train, you sweat out a ton of sodium. Without replacing this, if you continue to hydrate, you create the condition of hyponatremia (http://en.wikipedia.org/wiki/Hyponatremia) - not good.

If you are super-hydrating, be sure to compensate with electrolytes. There are other solutions than Gatorade that have less sugar.

Jeremy

I drink 4-5L a day and rarely add salt to my cooking. Do you think this might pose a problem Jeremy or is there enough sodium in the foods i eat? I eat alot of meat, fruits, and healthy fats with some veggies.

I really need to up my veggie intake. :nope:

I drink 4-5L a day and rarely add salt to my cooking. Do you think this might pose a problem Jeremy or is there enough sodium in the foods i eat? I eat alot of meat, fruits, and healthy fats with some veggies.

I really need to up my veggie intake. :nope:

It depends on the person. I sweat a LOT so I started added sodium. Signs you aren't getting enough sodium are swollen hands and feet, bloated face, stomach cramping, feeling of the liquids just "sloshing" in your stomach rather than being absorbed, and not having at least one clear urination every day.

Some people don't sweat as much and some people get plenty of sodium in the foods they naturally eat. If you are training intensely for 20 - 60 minutes it may not be an issue. I have to be extra diligent because my runs can last several hours so it becomes more of an issue.

Interesting note: when you have too much liquid and not enough sodium to balance then swelling occurs, and this may be the main cause of blisters for runners. I always thought shoes/socks/etc but a PhD in biochemistry who runs ultramarathons told me that if you can run 2 - 3 miles without blisters, then you should be able to run 50 - 100 miles without blisters. The only difference besides the obvious wear and tear is that if you aren't properly getting fluids AND electrolytes, your feet will swell and this will cause the blistering.

After having feet that looked like I would run barefoot across broken glass, I started focusing on more fluids and electrolytes during my runs. Behold, suddenly, despite running over 10 miles I no longer get blisters.

Another way I can tell is by weighing myself. If I take in water but no electrolytes, I sweat and urinate it out and lose several pounds during a long run. If I take it with electrolytes, I don't urinate as much and my body seems to use it more because I lose far less weight after the run - for example, I used to lose 4 - 5 pounds on a 8 mile run, today I ran 10 and only lost 1.5.

Jeremy

Very tragic. They broke two rules:

1. Not voiding ... considering voiding is the body's main way of regulating water balance as well as flushing toxins, and

2. Providing water with no electrolytes.

The (2) is where I see most people fail. They start an exercise program and are big on staying hydrated, but there is that stigma over sports drinks like Gatorade ("loaded with sugar") etc. But the fact of the matter is that when you train, you sweat out a ton of sodium. Without replacing this, if you continue to hydrate, you create the condition of hyponatremia (http://en.wikipedia.org/wiki/Hyponatremia) - not good.

If you are super-hydrating, be sure to compensate with electrolytes. There are other solutions than Gatorade that have less sugar.

Jeremy

Jeremy would you mind elaborating more on this? In another words, those that work out and keep themselves well hydrated should stock up on sodium?

Jeremy would you mind elaborating more on this? In another words, those that work out and keep themselves well hydrated should stock up on sodium?

No ... those that work out and sweat a lot should monitor their sodium intake. If you have those shirts that get white salt rings, then you might consider adding a few electrolytes. Again, for short workouts (< 1 hour) probably no big deal ... you'll more than likely replenish electrolytes throughout the day through foods. I've always been a huge fan of not artificially adding sodium to anything ... that's why I suffered so much on long runs without understanding that when I sweat, I lose a lot of sodium. Even moderately short runs of 40 - 50 minutes in the heat will affect me, so in that case, I do take in sodium ... what I've found works well is about 200mg per 16 oz of fluid, that's my "sweet" spot.

Here's some resources:

http://www.succeedscaps.com/sodiumanddehydration.html
http://www.ultrunr.com/hydrate.html
http://www.ultrunr.com/bev-brak.html
http://www.ultrunr.com/wtrgain.html

Using this advice has completely transformed my training and recovery.

Jeremy

Thanks for the info Jeremy. :)

The body/kidney regulates excretion of water/sodium from your body based on blood osmolality (concentration of electrolytes - mostly sodium) and volume status (hydration status). Not urinating does NOT prevent filtration of blood through your kidney with resulting "elimination" of water, electrolytes, etc. Holding your urine causes your bladder to increase in size and eventually it would be impossible to hold the urine in or if you can it'll result in "backup" of fluid into the collecting system in the kidneys (resulting in hydronephrosis); ultimately, though almost everyone will end of urinating. Chronic events like this will result in decreased tone of your bladder resulting in post-void residuals of urine (increased risk of infection).

You need to drink a LOT of pure water and perpsire a LOT to cause a sudden drop in your sodium to cause clinically significant hyponatremia, resulting in central nervous system injury/mental status changes. Drinking 4 liters of water a day and exercising will NOT cause this since your body is able to control "water" excretion and sodium absoprtion back into your blood through vasopressin secretion from your hypothalamus.

The article linked above is not telling the entire story. If there's no other relevant details missing, she has really bad luck.

I am a little confused on the article. It doesn't mention a physician supervising this event. Which is suprising because with an event like this physician should be present.

Also that lady was relatively young to have this happen. I am curious if there are any underlying medical conditions that were present such as diabetes.

Chronic events like this will result in decreased tone of your bladder resulting in post-void residuals of urine (increased risk of infection).
Women have a natural tendancy to 'hold' their bladder hence why some women get chronic UTI's. That why is go for people to go every 2 hours ideally.

Don't think you need to start fatally worrying unless you get to 9+ litre a day (size dependent of course). But for performance, that's a really cool point on the blisters. Thanks for that Jeremy.

Ecstacy intereferes with the 'thirst' part of the brain, I believe. That's the main reason why ecstacy users kick the bucket. They drink too much water!

I could be wrong, but wouldn't potassium be the more harmful electrolyte to worry about in relation to water intoxicatoin? Potassium is vital in all muscle contractions, especially that of cardiac muscle. With hyperkalemia/hypokalemia (high/low serum potassium) there is a risk of fatal arrythmias. I'm not very familiar with water intoxication, but I know a thing or two about electrolytes and sodium is not quite as dangerous as potassium, granted sodium and potassium have an inverse relationship.

Chris85:
Potassium is indeed critical for the heart muscle, but when the brain is rapidly swelling from water intoxication, it's no big deal if the heart skips a few beats.

For an otherwise healthy individual, one could easily tolerate a fairly significant drop in potassium, as the body has a vested interest in protecting the heart rhythm and thus has protective mechanisms, like shifting potassium in and out of cells to keep its level in the blood more stable.

It would take a mighty significant drop in potassium to run into trouble with fatal arrhythmias, whereas a rapid change in the sodium concentration obviously has catastrophic consequences.