I'm thinking SIADH - a _pathological_ entity ( see also Central
Diabetes Insipidus)
I'm know that asking a random medic about sodium will get you many
different answers.
I know that asking intensivists will get you a subtle difference of
opinion. (i.e. the choice Nigel was given. "Watchful waiting or
"controlled procrastination" ;))
I know that moving Na in any direction fast is bad. (I hope I can
spell central pontine demylin....ation bleh I give up)
I know that the easiest way to sort low Na is to restrict oral fluid
intake, but this is in _medically_ unwell people, which is why the
average doctor is not necessarily the best person to give an opinion
with respect to sports physiology in normal people. (that's my opinion
anyway)
In gliding we are looking at normal people (What?!? No engine in that
thing!) with normal physiology being stressed by heat and sunlight
radiation and the effects it has. The body attempts to compensate, we
need to consciously help to keep it operating optimally. Well
controlled, it is a small deviation, a stress. Turn up the stress
significantly (long blue day) on someone who may have started the day
on a backfoot (i.e. hungover) and it becomes pathological ("heat
stroke" etc)
One cannot use the techniques of sodium control from the ICU patient
to the sportsman.
I don't even vaguely claim to know the answer to the hydration
conundrum either. (I refuse to get into that...) Pee colour like any
clinical sign has its limitations. I personally will still use it as a
guide though, in context of course.
What I do know is that having convulsions related to sodium is a VERY
bad thing and I'm glad you're still with us Nigel. I'd call that a
seriously low save ;)
Cheers
A.J.
On 6/13/07, nandrews <[EMAIL PROTECTED]> wrote:
>
>
>
> Hi all,
>
>
>
> Firstly, thanks to those who sent their best wishes and support, plus visits
> to the hospital – really helps.
>
>
>
> A short story in a layman's terms cause I isn't qualified (plus bad
> grammar)……
>
>
>
> After a routine op on a Pituitary gland cist (yes they found a brain as well
> which I believe Michele left instructions to cut out the gliding neurons) I
> came home feeling great, discharged early. A week later I was in hospital
> again and not good, vomiting, uncontrolled convulsions, shivers then heat,
> passing out – not a good state and ready for ITU ward. My Endocrinologist
> was rushed in, immediate blood tests, MRI and xrays on the stomach –
> everything. O.K 2 hours later results – sodium had fallen to 117mmol (
> normal is 137 to 147 in Oz ) and a 2 minute decision was needed, intense ICU
> supervised sodium infusion with potential brain damage as a side effect (yeh
> yeh don't make the jokes now – I can already hear them) OR try a reduced
> liquid intake via IV with SOME saline, try and get it back slowly, albeit I
> was going to suffer for the next 24 hours, I elected the no brain damage
> option and with a shot of valium in the bum (wish I had a photo of my facial
> expression) went to sleep much to the relief of Michele. 5 days later a near
> full recovery albeit some Asthma which I didn't have before – unrelated. The
> Pituitary was damaged by the op and it temporally ceased sodium production
> or at least reduced it heaps causing the emergency.
>
>
>
> O.K what's this leading to, well many armchair talks during the recovery
> with a renowned Endocrinologists reveals some real myths in the super
> hydration stuff, to the point it can cause damage, maybe death and has
> little or no benefit. Funny thing, until recently like 5 years ago I used to
> drink water when I felt thirsty, it was till I attended coaching, listened
> to my peers talk about hydrating up, drink a litre an hour etc etc, all of a
> sudden pissing like crazy and not really feeling any different than the
> previous 17 odd years doing it my way and all of the time risking reducing
> the very sodium levels we need to stay alive. I guess we just don't know
> what they are, well I do but most would not and what are they if you drink 4
> litres before a flight then 1 litre an hour – guys, we are not running
> across the dessert. I know this may be a rather disjointed writing document
> as I still feel a bit dizzy but I thought it important enough to get to
> paper before I forgot it. IF you loose sodium a quick recovery is NOT more
> sodium, i.e salt tablets etc or sports drinks as this only makes it worse,
> sodium absorbs more water into the blood this making the level even more
> less than before – hey, something I never knew but what an eye opener!
> Endocrinologists are body chemistry specialists and mine had 50 years of
> experience and a passion for his work – bloody saved my life I believe.
>
>
>
> Before Neurosurgeons brought in Endos they were loosing patients sometimes
> as there was no understanding of the sodium thing, they approach was to
> simply add some salt – just made it worst!
>
>
>
> O.K enough from me, the brains shutting down. Please limit any criticisms to
> constructive stuff, I am sure there a hordes of experts going to drown this
> BUT this will change the way I "HYDRATE", i.e back to the way I used to do
> it, drink before flying when I felt thirsty and sip on water when I need it
> in flight, if I do start to get a headache on a blue day drink a bit more
> but no more camel storing super hydration techniques.
>
>
>
> Following a a text story on the Boston marathon and a death from sodium
> depletion – interesting and controversial , and one thing I remembered, the
> talk on electrolyte renewal – O.K what was the starting level of the
> electrolytes before you started pumping more in? Staminade, Gatorade – makes
> the manufacturers happy you are buying it. One last thing, the urine chart
> on pee colour, what a load of crap! Colour has not much to do with
> hydration, take a vitamin pill and see what colour it goes, eat a pumpkin,
> take some food dye you can make it blue – hydration can only be measured by
> some pretty sophisticated instruments and process, another myth on the
> urinal wall – boy that's going to start it up.
>
>
>
> Cheers and thanks again
>
>
>
> Nigel
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