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Heat Illness & Hydration John Neidecker, DO, ATC Sports Medicine Physician Cooper Bone & Joint Institute Why do we sweat? • To cool the body down • High body temperatures can lead to organ damage • As muscles contract – heat is produced How do we sweat? • Neurological response • Skin blood vessels vasodialate – stimulating sweat glands • Sweat evaporates and cools the skin What does sweat contain? • Water • Urea • Electrolytes – Sodium The composition is highly variable between individuals • • • • Person Environment Body weight Acclimated/Fitness level Performance & Hydration • Performance has been shown to decrease secondary to dehydration – Physically – Mentally • Decreases start to happen when there is a decrease in total body water of 2% Performance & Hydration • People do not perceive the feeling of being thirsty until there is a decrease in total body water of 3% When things go wrong… • Sweat response becomes dysfunctional resulting in – An increase in body temperature – An electrolyte imbalance Electrolyte Imbalance • Levels too high or too low can cause – Arrhythmias – Seizure – Brain damage Hyperthermia • Increase in body temperature can lead to – Heat Stroke – Heat Exhaustion – Heat Cramps Heat Stroke • Defined by – Body temp > 104 F – CNS Dysfunction – Organ Damage Heat Exhaustion • Inability to continue exercising • Brain mediated “safety break” • Temperature not as high as HS Heat Cramps • Painful muscle cramps – calves • Associated with large amounts of sodium loss Who’s at risk for heat illness? • • • • Those who have had it before Out of shape/Unacclimatized Overweight Age Warning signs • • • • • Change in mental status Dizziness Difficulty walking Vomiting Hyperventilation Confused with Concussion • Take a temperature What to do if suspected • Remove athlete from play!!!!! • Call EMS • Place athlete in a shaded area • Ice – Emersion – Bags on head, neck, armpits, groin Quick Aside • Sickle Cell Trait – Not a heat illness – Crisis triggered by • Dehydration • Hypoxemia – NCAA D1 – Screening – Does not disqualify from participation Prevention • • • • Go into practice fully hydrated Wear light colored, loose fitting clothing Exercise during the cooler parts of the day Acclimate over time – Start 10-14 days before training camp – Start at 10 minutes – Increase by another 10 minutes every 2 days Hydration Guidelines • Drink 16 oz of water or sports drink one hour before exercise • Drink 4-8 oz every 15-20 minutes of exercise • Exercising less than an hour, drink water • Exercising more than an hour, drink a sports drink » 16 oz is about half a liter After Exercise Hydration • Weigh yourself before and after practice – For every 2 lbs lost drink 48 oz • If your urine is dark – you are not drinking enough History of Gatorade • Created by researchers at the University of Florida in 1965 – “Gator”-aid • Legend of the 1967 Orange Bowl win over Georgia Tech Pickle Juice • Anecdotally, helps with muscle cramps • High in sodium Chocolate Milk • Post-work out drink • Increase protein synthesis • Increases muscle glycogen • 16 oz about 40 min after work out • Low-fat References • Armstrong, LE, et. al, American College of Sports Medicine Position Stand: Exertional heat illness during training and competition., Med Sci Sport Exer. 2007. pgs 556-572 • Sawka, MN, et. al, American College of Sports Medicine Position Stand: Exercise and fluid replacement., Med Sci Sport Exer. 2007. pgs 377-390