scholarly journals Sodium Replacement and Plasma Sodium Drop During Exercise in the Heat When Fluid Intake Matches Fluid Loss

2009 ◽  
Vol 44 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Costas A. Anastasiou ◽  
Stavros A. Kavouras ◽  
Giannis Arnaoutis ◽  
Aristea Gioxari ◽  
Maria Kollia ◽  
...  

Abstract Context: Sodium replacement during prolonged exercise in the heat may be critically important to maintaining fluid and electrolyte balance and muscle contractility. Objective: To examine the effectiveness of sodium-containing sports drinks in preventing hyponatremia and muscle cramping during prolonged exercise in the heat. Design: Randomized crossover study. Patients or Other Participants: Thirteen active men. Intervention(s): Participants completed 4 trials of an exercise protocol in the heat (30°C) consisting of 3 hours of exercise (alternating 30 minutes of walking and cycling at a heart rate of 130 and 140 beats per minute, respectively); a set of standing calf raises (8 sets of 30 repetitions); and 45 minutes of steep, brisk walking (5.5 kmṡh−1 on a 12% grade). During exercise, participants consumed fluids to match body mass loss. A different drink was consumed for each trial: carbohydrate-electrolyte drink containing 36.2 mmol/L sodium (HNa), carbohydrate-electrolyte drink containing 19.9 mmol/L sodium (LNa), mineral water (W), and colored and flavored distilled water (PL). Main Outcome Measure(s): Serum sodium, plasma osmolality, plasma volume changes, and muscle cramping frequency. Results: During both HNa and LNa trials, serum sodium remained relatively constant (serum sodium concentration at the end of the protocol was 137.3 mmol/L and 136.7 mmol/L, respectively). However, a clear decrease was observed in W (134.5 ± 0.8 mmol/L) and PL (134.4 ± 0.8 mmol/L) trials compared with HNa and LNa trials (P < .05). The same trends were observed for plasma osmolality (P < .05). Albeit not significant, plasma volume was preserved during the HNa and LNa trials, but a reduction of 2.5% was observed in the W and PL trials. None of the volunteers experienced cramping. Conclusions: The data suggest that sodium intake during prolonged exercise in the heat plays a significant role in preventing sodium losses that may lead to hyponatremia when fluid intake matches sweat losses.

1991 ◽  
Vol 70 (1) ◽  
pp. 342-348 ◽  
Author(s):  
R. A. Irving ◽  
T. D. Noakes ◽  
R. Buck ◽  
R. van Zyl Smit ◽  
E. Raine ◽  
...  

Renal function including fluid and electrolyte balance was studied during recovery in eight subjects who developed symptomatic hyponatremia (HN; plasma sodium concentration less than 130 mM) during an 88-km ultramarathon footrace and compared with results for normonatremic runners [NN; n = 18, mean postrace plasma sodium concentration, 138.2 +/- 1.2 (SE) mM]. Estimated fluid intake during the race for HN was 12.5 +/- 1.6 (SE) liters over 9 h 41 min (+/- 28 min). HN excreted a net fluid excess of 2.95 +/- 0.56 (range 1.2–5.9) liters compared with a fluid deficit of 2.7 +/- 0.3% body weight in NN. The sodium deficit was 153 +/- 35 mmol in HN and 187 +/- 37 mmol in NN. Despite the fluid overload, plasma volume was decreased by 24.1 +/- 5.0% in HN compared with 8.2 +/- 2.6% in NN. Serum renin activity (5.1 +/- 2.0 ng.ml-1.h-1), aldosterone concentrations (410 +/- 34 ng/l), creatinine clearances (174.8 +/- 28.2 ml/min), and urine output (6.4 +/- 1.0 ml/min) were markedly elevated in HN during recovery. Thus the hyponatremia of exercise results from fluid retention in subjects who ingest abnormally large fluid volumes during prolonged exercise.


1985 ◽  
Vol 249 (2) ◽  
pp. H321-H327 ◽  
Author(s):  
C. A. Bruner ◽  
J. M. Weaver ◽  
G. D. Fink

Experiments were performed to characterize the hypertension produced by chronic intracerebroventricular (ICV) infusion of angiotensin II (ANG II) in conscious rats. Infusion of ANG II into a lateral cerebral ventricle for 5 days (1 or 6 micrograms/h) produced dose-dependent increases in mean arterial pressure associated with increased water intake. No consistent changes in heart rate, urinary electrolyte excretion, or water balance were observed. Similarly, no alterations in plasma sodium and potassium concentration, plasma osmolality, or plasma ANG II levels were seen during ICV ANG II infusion. Controlling fluid intake at 40 ml/day did not alter the development of hypertension in this model. Hypertension was found to be sodium dependent, with high sodium intake augmenting the increase in arterial pressure in response to chronic ICV ANG II. Although plasma aldosterone concentrations were increased in some situations during ICV ANG II infusion, adrenalectomy failed to alter the course of hypertension. This study demonstrates that chronic selective stimulation of brain ANG II receptors by means of continuous ICV infusion of ANG II produces sodium-sensitive increases in arterial pressure associated with, but not dependent on, increased fluid intake. This form of hypertension cannot be attributed to sodium and water retention, elevations in plasma aldosterone, or leak of significant amounts of ANG II from cerebrospinal fluid into the peripheral circulation.


2015 ◽  
Vol 50 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Michael A. McKenney ◽  
Kevin C. Miller ◽  
James E. Deal ◽  
Julie A. Garden-Robinson ◽  
Yeong S. Rhee

Context: Twenty-five percent of athletic trainers administer pickle juice (PJ) to treat cramping. Anecdotally, some clinicians provide multiple boluses of PJ during exercise but warn that repeated ingestion of PJ may cause hyperkalemia. To our knowledge, no researchers have examined the effect of ingesting multiple boluses of PJ on the same day or the effect of ingestion during exercise. Objective: To determine the short-term effects of ingesting a single bolus or multiple boluses of PJ on plasma variables and to characterize changes in plasma variables when individuals ingest PJ and resume exercise. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Nine euhydrated men (age = 23 ± 4 years, height = 180.9 ± 5.8 cm, mass = 80.7 ± 13.8 kg, urine specific gravity = 1.009 ± 0.005). Intervention(s): On 3 days, participants rested for 30 minutes, and then a blood sample was collected. Participants ingested 0 or 1 bolus (1 mL·kg−1 body weight) of PJ, donned sweat suits, biked vigorously for 30 minutes (approximate temperature = 37°C, relative humidity = 18%), and had a blood sample collected. They either rested for 60 seconds (0- and 1-bolus conditions) or ingested a second 1 mL·kg−1 body weight bolus of PJ (2-bolus condition). They resumed exercise for another 35 minutes. A third blood sample was collected, and they exited the environmental chamber and rested for 60 minutes (approximate temperature = 21°C, relative humidity = 18%). Blood samples were collected at 30 and 60 minutes postexercise. Main Outcome Measure(s): Plasma sodium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume. Results: The number of PJ boluses ingested did not affect plasma sodium concentration, plasma potassium concentration, plasma osmolality, or changes in plasma volume over time. The plasma sodium concentration, plasma potassium concentration, and plasma osmolality did not exceed 144.6 mEq·L−1 (144.6 mmol·L−1), 4.98 mEq·L−1 (4.98 mmol·L−1), and 289.5 mOsm·kg−1H2O, respectively, in any condition at any time. Conclusions: Ingesting up to 2 boluses of PJ and resuming exercise caused negligible changes in blood variables. Ingesting up to 2 boluses of PJ did not increase plasma sodium concentration or cause hyperkalemia.


2014 ◽  
Vol 49 (3) ◽  
pp. 360-367 ◽  
Author(s):  
Kevin C. Miller

Context: Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. Objective: To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na+) concentration ([Na+]p), plasma potassium (K+) concentration ([K+]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na+ content. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). Intervention(s): Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na+ as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. Main Outcome Measure(s): The dependent variables were [Na+]p, [K+]p, OSMp, and percentage change in plasma Na+ content and plasma volume. Results: Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na+, 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K+, and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na+ in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na+]p, [K+]p, OSMp, or percentage changes in plasma volume or Na+ content (P > .05). Conclusions: Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.


1997 ◽  
Vol 87 (4) ◽  
pp. 499-507 ◽  
Author(s):  
Beatriz R. Olson ◽  
Julie Gumowski ◽  
Domenica Rubino ◽  
Edward H. Oldfield

✓ Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery were studied. To evaluate posterior pituitary damage, a questionnaire was completed immediately after surgery in 61 patients. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after surgery. Patients were categorized on the basis of postoperative plasma sodium patterns. After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 ± 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients after water-load testing. Only one-third of the normonatremic patients excreted the water load and suppressed AVP normally. Hyponatremic patients were more natriuretic, had lower dietary sodium intake, and had similar fluid intake and cortisol and atrial natriuretic peptide (ANP) levels compared with normonatremic patients. Normonatremia, hyponatremia, and diabetes insipidus were associated with increasing degrees of surgical manipulation of the posterior lobe and pituitary stalk during surgery. The pathophysiology of hyponatremia after transsphenoidal surgery is complex. It is initiated by pituitary damage that produces AVP secretion and dysfunctional osmoregulation in most surgically treated patients. Additional events that act together to promote the clinical expression of hyponatremia include nonatrial natriuretic peptide—related excess natriuresis, inappropriately normal fluid intake and thirst, as well as low dietary sodium intake. Patients should be monitored closely for plasma sodium, plentiful dietary sodium replacement, mild fluid restriction, and attention to symptoms of hyponatremia during the first 2 weeks after transsphenoidal surgery.


2009 ◽  
Vol 44 (5) ◽  
pp. 454-461 ◽  
Author(s):  
Kevin C. Miller ◽  
Gary Mack ◽  
Kenneth L. Knight

Abstract Context: Health care professionals advocate that athletes who are susceptible to exercise-associated muscle cramps (EAMCs) should moderately increase their fluid and electrolyte intake by drinking sport drinks. Some clinicians have also claimed drinking small volumes of pickle juice effectively relieves acute EAMCs, often alleviating them within 35 seconds. Others fear ingesting pickle juice will enhance dehydration-induced hypertonicity, thereby prolonging dehydration. Objective: To determine if ingesting small quantities of pickle juice, a carbohydrate-electrolyte (CHO-e) drink, or water increases plasma electrolytes or other selected plasma variables. Design: Crossover study. Setting: Exercise physiology laboratory. Patients or Other Participants: Nine euhydrated, healthy men (age  =  25 ± 2 years, height  =  179.4 ± 7.2 cm, mass  =  86.3 ± 15.9 kg) completed the study. Intervention(s): Resting blood samples were collected preingestion (−0.5 minutes); immediately postingestion (0 minutes); and at 1, 5, 10, 15, 20, 25, 30, 45, and 60 minutes postingestion of 1 mL/kg body mass of pickle juice, CHO-e drink, or tap water. Main Outcome Measure(s): Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume were analyzed. Urine specific gravity, osmolality, and volume were also measured to characterize hydration status. Results: Mean fluid intake was 86.3 ± 16.7 mL. Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma osmolality, and plasma volume did not change during the 60 minutes after ingestion of each fluid (P ≥ .05). Water ingestion slightly decreased plasma potassium concentration at 60 minutes (0.21 ± 0.14 mg/dL [0.21 ± 0.14 mmol/L]; P ≤ .05). Conclusions: At these volumes, ingestion of pickle juice and CHO-e drink did not cause substantial changes in plasma electrolyte concentrations, plasma osmolality, or plasma volume in rested, euhydrated men. Concern that ingesting these volumes of pickle juice might exacerbate an athlete's risk of dehydration-induced hypertonicity may be unwarranted. If EAMCs are caused by large electrolyte loss due to sweating, these volumes of pickle juice or CHO-e drink are unlikely to restore any deficit incurred by exercise.


1988 ◽  
Vol 75 (4) ◽  
pp. 441-444 ◽  
Author(s):  
David J. Leehey ◽  
Alicia A. Picache ◽  
Gary L. Robertson

1. Studies were performed in five hyponatraemic (plasma sodium 129 ±1.6 mmol/l; plasma osmolality 268 ±3.0 mosmol/kg) quadriplegic patients in order to elucidate its aetiology. Five age- and sex-matched healthy subjects served as controls. 2. Daily urine volumes were high (4454 ± 624 ml) in the quadriplegic patients secondary to habitually increased fluid intake. 3. All quadriplegic patients had suppressed plasma arginine vasopressin levels (< 0.8 pmol/l) and were able to form dilute urine after a water load (20 ml/kg). However, free water clearance and the ability to excrete the water load were frequently impaired, and these defects were associated with reductions in both osmolar clearance and delivery of filtrate to the distal diluting sites of the nephron. 4. During hypertonic saline (5%, w/v, NaCl) infusion, plasma arginine vasopressin rose progressively before plasma osmolality reached the normal range, consistent with a resetting of the osmostat. 5. We conclude that hyponatraemia in quadriplegic patients is related to an intrarenal defect in water excretion and resetting of the osmostat coupled with increased fluid intake.


1988 ◽  
Vol 118 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Kyuzi Kamoi ◽  
Fujio Sato ◽  
Okuhiro Arai ◽  
Miyuki Ishibashi ◽  
Tohru Yamaji

Abstract. To clarify the role of blood volume and osmolality in the mediation of the release of atrial natriuretic peptide (ANP) and to examine the relationship between plasma ANP and plasma AVP levels in man, the effects of hypertonic saline and hypertonic mannitol infusion, and of water load on plasma levels of ANP and AVP were studied. Infusion of 5% saline to 7 healthy men at a rate of 0.05 ml min−1·kg−1 for 2 h resulted in a parallel rise in plasma sodium, osmolality, plasma ANP and plasma AVP, indicating that plasma hyperosmolality stimulates secretion of both ANP and AVP. Infusion of 20% mannitol to 6 healthy men at the same rate resulted in a parallel increase in plasma osmolality, plasma ANP and AVP, whereas plasma sodium decreased, indicating that plasma hyperosmolality stimulates secretion of both ANP and AVP. Water load (20 ml/kg) into 7 healthy men produced a prompt and parallel fall in plasma sodium, plasma osmolality and plasma AVP. In contrast, plasma ANP and plasma volume, calculated from the changes in hematocrit, increased concomitantly, which indicates that expanded plasma volume stimulates secretion of plasma ANP. These results suggest that secretion of ANP in man is regulated principally by plasma volume, which may be modulated by a change in plasma osmolality. AVP secretion, on the other hand, is controlled mainly by osmotic change and secondarily by plasma volume.


1997 ◽  
Vol 22 (1) ◽  
pp. 48-57 ◽  
Author(s):  
Jan M. Schroeder ◽  
Kris L. Heck ◽  
Jeffrey A. Potteiger

The effectiveness of a new water delivery system (the Water-Del) was examined for maintaining euhydration compared to other fluid replacement strategies. Subjects (N = 10) performed three 60-min cycling trials (@ 50% of VO2max) in an environmental chamber (27 °C; RH = 50%). Trials were randomly assigned from Water-Del (metered: 200 ml water every 15 min), ad libitum every 15 min (ad-lib-15), and ad libitum (ad-lib). Total water intake (TWI), changes in plasma volume (ΔPV), body Weight (ΔBW), thirst, skin temperature (Tsk), and heart rate (HR) were measured. A significant difference (p ≤.05) among trials was observed for TWI, with metered (1.200 ± 0.12 ml) being greater than ad-lib-15 (358 ± 48 ml) and ad-lib (522 ± 106 ml). No significant difference was found for ΔPV. A significant difference (p ≤.05) for ΔHW was observed with metered (0.28 ± 0.16 kg) being different than ad-lib-l5 (−0.63 ± 0.12 kg) and ad-lib (−0.34 ± 0.14 kg). No significant differences (p > .05) were found for thirst, Tsk, or HR. The Water-Del provides for greater fluid intake during exercise compared to other replacement strategies. Key words: hydration, dehydration, plasma volume


2018 ◽  
Vol 315 (4) ◽  
pp. R688-R695 ◽  
Author(s):  
Matthew C. Babcock ◽  
Michael S. Brian ◽  
Joseph C. Watso ◽  
David G. Edwards ◽  
Sean D. Stocker ◽  
...  

High dietary sodium intake has been linked to alterations in neurally mediated cardiovascular function, but the effects of high sodium on cardiovagal baroreflex sensitivity (cBRS) in healthy adults are unknown. The purpose of this study was to determine whether high dietary sodium alters cBRS and heart rate variability (HRV) and whether acute intravenous sodium loading similarly alters cBRS and HRV. High dietary sodium (300 mmol/day, 7 days) was compared with low dietary sodium (20 mmol/day, 7 days; randomized) in 14 participants (38 ± 4 yr old, 23 ± 1 kg/m2 body mass index, 7 women). Acute sodium loading was achieved via a 23-min intravenous hypertonic saline infusion (HSI) in 14 participants (22 ± 1 yr old, 23 ± 1 kg/m2 body mass index, 7 women). During both protocols, participants were supine for 5 min during measurement of beat-to-beat blood pressure (photoplethysmography) and R-R interval (ECG). cBRS was evaluated using the sequence method. Root mean square of successive differences in R-R interval (RMSSD) was used as an index of HRV. Serum sodium (137.4 ± 0.7 vs. 139.9 ± 0.5 meq/l, P < 0.05), plasma osmolality (285 ± 1 vs. 289 ± 1 mosmol/kgH2O, P < 0.05), cBRS (18 ± 2 vs. 26 ± 3 ms/mmHg, P < 0.05), and RMSSD (62 ± 6 vs. 79 ± 10 ms, P < 0.05) were increased following high-sodium diet intake compared with low-sodium diet intake. HSI increased serum sodium (138.1 ± 0.4 vs. 141.1 ± 0.5 meq/l, P < 0.05) and plasma osmolality (286 ± 1 vs. 290 ± 1 mosmol/kgH2O, P < 0.05) but did not change cBRS (26 ± 5 vs. 25 ± 3 ms/mmHg, P = 0.73) and RMSSD (63 ± 9 vs. 63 ± 8 ms, P = 0.99). These data suggest that alterations in dietary sodium intake alter cBRS and HRV but that acute intravenous sodium loading does not alter these indexes of autonomic cardiovascular regulation.


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