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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