Body weight post race was inversely associated with serum sodium i.e. less weight loss was associated with lower serum sodium. Body weight loss was unrelated to marathon time.
Treatment of exercise-associated hyponatremia with hypertonic IV infusion to correct plasma sodium levels is also a standard and accepted use of IV fluid infusions
athletes who present for medical care with hypernatremia who cannot tolerate oral fluids can benefit from IV fluids
Vaporization of sweat accounts for 80% of heat loss in hot, dry atmospheric conditions. This mechanism of water loss is the major contributor for exercise-associated dehydration
The rate of water loss can be quantified through measurement of sweat rate
Pre- and postexercise body weight measurements are the most common means to estimate overall water loss but are condition specific
It appears that 1% to 2% body weight loss is well tolerated by the exercising athlete
Dehydration, defined as greater than 2% loss of body weight, can negatively affect performance
In highly trained endurance athletes, plasma volume and sodium serum concentration were preserved despite a 5% body weight loss
In Ironman triathletes, dehydration to 5% body weight loss did not correlate with occurrence of medical complications
hydration should begin hours prior to exercise, especially if known deficits are present, and fluids should be consumed at a slow, steady rate, with 5 to 7 mL/kg taken 4 hours prior to exercise
Sodium concentration did not produce significant changes in the rate of absorption but was primarily dependent on carbohydrate concentration
Replacing 150% of body weight loss over 60 minutes has been tolerated without complications
IV treatment of severe dehydration (>7% body weight loss), exertional heat illness, nausea, emesis, or diarrhea, and in those who cannot ingest oral fluids for other reasons, is clinically indicated
A recent survey of the National Football League teams revealed that 75% (24 of 32) of the teams utilized IV infusion of fluids for prehydration in at least some otherwise healthy individuals
In the National Football League, an average of 1.5 L of normal saline was administered approximately 2.5 hours prior to competition
after 2 hours of exercise, the rectal temperature was 0.6° higher in the group not receiving IV infusion. Also, stroke volume and cardiac output were 11% to 16% lower in the control group versus the IV infusion group.
Recent evidence suggests the etiology of EAMC is related to muscle fatigue and neuronal excitability
no correlation between hydration status or electrolyte concentrations with EAMC
there may be a subset of muscle cramping that is associated with a loss of both body fluid and sodium
Glycerol is the primary agent for oral hyperhydration
elevation of plasma volume by 200 to 300 mL via dextran infusion resulted in 15% increase in stroke volume, 4% increase in VO2 max, and an increase in the exercise time to fatigue
Neither the tonicity nor mode of hydration resulted in improved speed of rehydration, greater fluid retention, or improved performance
There are beneficial anecdotal reports of EAMC treatment in elite and professional-level athletes with IV hydration during the course of an event
Plasma volume was better restored during rehydration with IV fluids at preexercise and 5 minutes of exercise. At 15 minutes, there was no difference between IV and oral rehydration
More rapid restoration of plasma volume was accomplished in the IV treatment group with no advantages over oral rehydration in physiological strain, heat tolerance, ratings of perceived effort, or thermal sensations
No difference was found in exercise time to exhaustion. IV and oral rehydration methods were equally effective. Heart rates were statistically higher in the oral rehydration group through 75 minutes of exercise, and there were higher increases in norepinephrine plasma concentrations
No significant differences between the groups were found for time to recovery, number of days with pain, number of days with stiffness, sleep disturbance, fatigue, rectal temperature, and loss of appetite
The current data suggest that IV rehydration is faster than oral
There may be physiological benefits of decreased heart rate and norepinephrine in athletes rehydrated via IV route
Postexercise blood 1 hour and 24 hours showed no differences in circulating myoglobin or creatine kinase
The use of IV fluid may be beneficial for a subset of fluid sensitive athletes
this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings.
Volume expanders may also be beneficial for some athletes
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The brand name "Nembutal" was coined by Dr. John S. Lundy, who started using it in 1930, from the structural formula of the sodium salt-Na (sodium) + ethyl + methyl + butyl + al (common suffix for barbiturates). Nembutal is trademarked and manufactured by the Danish pharmaceutical company Lundbeck
crucial role of the RAS in the development and maintenance of cancer
kidneys, which produce renin in response to decreased arterial pressure, reduced sodium in the distal tubule, or sympathetic nervous system activity via the β-adrenergic receptors
Renin is secreted from the juxtaglomerular cells into the bloodstream where it encounters angiotensinogen (AGN), normally produced by the liver
Renin catalyses the conversion of AGN to angiotensin I (ATI), which is quickly cleaved by angiotensin converting enzyme (ACE) to form angiotensin II (ATII)
ATII triggers the release of aldosterone from the adrenal glands, which stimulates reabsorption of sodium and water and thereby increases blood volume and blood pressure
ATII also acts on smooth muscle to cause vasoconstriction of the arterioles
ATII promotes the release of antidiuretic hormone from the posterior pituitary gland, which results in water retention and triggers the thirst reflex
ability of non-CSCs to ‘de-differentiate’ into CSCs due to epigenetic or environmental factors, which further increases the complexity of tumour biology and treatment
efficacy of RAS modulators on cancer in both cancer models and cancer patients
A localised (‘paracrine’) RAS mechanism has been identified in many types of cancers, and interruption of the control of the RAS is thought to be the basis for its role in cancer
Components of the RAS are expressed by these CSCs, supporting the hypothesis of the presence of a ‘paracrine RAS’ in regulating these CSCs
Renin is an enzyme normally released by the kidneys in response to falling arterial pressure
a study of GBM demonstrating overexpression of PRR coupled with the observation that inhibition of renin reduces cellular proliferation and promotes apoptosis
PRR has been found to be vital for normal Wnt signalling
A major focus of PRR research is its relationship with Wnt signalling
suggest a crucial role for PRR activation on the proliferation of CSCs, possibly via Wnt/β-catenin signalling, leading to carcinogenesis.
Angiotensin converting enzyme (ACE), also known as CD143, is the endothelial-bound peptidase which physiologically converts ATI to ATII
ACE is crucial in the regulation of blood pressure, angiogenesis and inflammation
results suggest that an overactive ACE promotes cancer growth and progression, and an inhibited or low-activity ACE may have cancer-protective effects
When bound to ATII or ATIII it causes vasoconstriction by stimulating the release of vasopressin, reabsorption of water and sodium by promoting secretion of aldosterone and insulin, fibrosis, cellular growth and migration, pro-inflammation, glucose release from the liver, increased plasma triglyceride concentration, and reduced gluconeogenesis
ATIIR1 is a G-protein-coupled receptor, with downstream signalling involved in vasodilation, hypertrophy and NF-κB activation leading to TNF-α and PAI-1 expression
ATIIR1 has well-documented links with cancer, with one study demonstrating its overexpression in ~20% of breast cancer patients
the effect of RAS dysregulation has been associated with increased VEGF expression and angiogenesis in cancers
In ovarian and cervical cancer, ATIIR1 overexpression has been shown to be an indicator of tumour invasiveness
administration of ATIIR1 blockers (ARBs) have been associated with reduced tumour size, reduction in tumour vascularisation, lower occurrence of metastases, and lower VEGF levels
Good case review of secondary adrenal insufficiency. A common cause of low sodium and needs to be considered in elderly patients. Also, low cortisol is associated with increased ADH. In the case of adrenal insufficiency, the negative feed back of cortisol to the HPA is lost and recreation of CRH, which is an ADH secretagogue, will increase ADH secretion.
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hypothyroidism and hyponatremia is a rare finding; more commonly associated with severe hypothyroidism. Co-exisitng medical complications need to be considered.