Christopher, (Response apologetically delayed by air travel, car rental and 
driving to my mother's home) The sodium depletion is something most folks 
are less sensitive to when sweat-depleting electrolytes. Physiologic 
situations differ, bigger people will tend to sweat out more sodium. Some 
people just have odd sweat composition, I had a customer who had very high 
acetic acid content in his sweat and corroded front derailleurs into 
dysfunction and etched cranksets with his perspiratory output. Weird. Just 
part of nature wonderful variability. 

Potassium always gets equal billing with sodium in general discussions 
(that "pump" in membrane walls), but it is lots more troubling when out of 
balance because of the difficulty normalizing compared to sodium. This is 
mostly because of where it is normally, inside the cells, not just in the 
extracellular juice of your body. 

When I have a patient with low potassium the basic answer is IV fluid with 
dextrose and potassium because the potassium will follow the dextrose into 
the cells. This is not done quickly as compensations occur when those 
levels get off and rapid normalization can produce equally harmful 
electrolyte imbalances in that setting. If a potassium level has dropped so 
fast that it isn't compensated by the body, bad things start to happen. 
Patients in that situation will get what we call "K-runs" or potassium 
infusions and often require ICU level care for the acuity of monitoring as 
the electrolytes normalize and the infusions themselves...potassium has a 
high rate of making an IV site go bad and any resulting extravasation into 
surrounding tissue is bad. 

A good primer on the exercise induced imbalances (even though they're 
plugging their electrolyte solutions):

Sweat isn't the only culprit in potassium depletion: 
the stuff people eat/drink in response to exercise that isn't at all a part 
of their normal balance of intake and can cause enteral "dumping", a fancy 
way to say diarrhea. That and vomiting are major causes of lost potassium, 
the biggest concern is smooth muscle dysfunction (think cramps). not what 
you want your bowels, vasculature, airway walls or heart to start doing. 

This electrolyte depletion/repletion thing is serious stuff if you are 
sweating heavily for more than an hour. There is a time and place for 
banner statements but it behooves anyone participating in such activity to 
know if they are predisposed to any particular depletion, be it sodium 
because they are big or potassium because they are on an entry level 
antihypertensive with a diuretic component. 

Knowing how to tend to your fluid/electrolyte situation under normal 
regular activity stress can be a bit of trial and error. You will do some 
kidney harm if you don't supply your renal function with some water to 
excrete with the wastes removed by renal function. Your doctor checks BUN 
and Cr annually to see your baseline renal excretion performance, but under 
exercise stress they will rise as you dehydrate and produce muscle 
breakdown byproducts to be removed from your circulatory volume. If that 
goes overboard, you *will* learn about rhabdomyolysis. 

Eesh, I gotta stop and go to bed, after I drink a big glass of water. 

Andy Cheatham 
(Hot Springs, AR tonight)

On Wednesday, June 13, 2018 at 2:10:48 PM UTC-5, Christopher Cote wrote:
> Andy, thanks for your response. I have read about that before and 
> understand it as well as someone who got an A in high school biology class, 
> but has no further training can. In my limited experience,I have 
> experienced a severe "bonk" feeling when in ketosis after a hot, high 
> effort ride drinking only water. I have not experienced the bonk when 
> drinking my electrolyte solution. In neither case do I think I was 
> seriously dehydrated, but I may have been low on sodium?
> Chris

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