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Blood Test Results from IMNZ: Post Race.
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Tom Demerly
Mar 17, 04 14:24
Post #1 of 25 (1511 views)
Blood Test Results from IMNZ: Post Race.
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Here are the results of my blood test following Ironman New Zealand, administered by a doctor conducting a study at the event that I participated in:
My Serum sodium concentration: 136 mmol/L
(136 -146)is about normal range.
My Serum potassium concentration 5.3 mmol/L
(3.5 - 5.0)is about normal range.
My Serum urea concentration 9.5 mmol/L
(2.7 – 7.8)is about normal range.
My Serum creatinine concentration 0.16 mmol/L
(0.05 – 0.11)is about normal range.
Any physicians out there I would be interested in your interpretations/analysis.
devashish_paul
Mar 17, 04 14:58
Post #2 of 25 (1440 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Congrats. You ended Ironman NZ dehydrated but not hyponatremic. Usually when you sweat that much, you can't keep up on replacing your electrolytes. Looks like you are either a low salt sweat guy, or you managed both your sodium and potassium replenishment in a great way.
taku
Mar 17, 04 15:10
Post #3 of 25 (1395 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Basically you are dehydrated, and have kidneys which were able to compensate for the punishment you laid out to them.
BUN and K can be elevated through cell damage (red blood cell breakdown, muscle breakdown) in addition to not clearing it as efficiently after
it would be interesting to see alot of other things in your blood work, ie cpk (muscle breakdown) your H/H (amount of RBC in your blood) haptoglobin, glucose, etc. to see how much hemolysis you were going through, how much you were dehydrated, etc.
I saw a very interesting poster presentation at an Emergency Medicine Conference in Boston last year about post iron Man blood levels... I wonder if it was the same people.
Any idea what the doc was lookign at?
devashish_paul
Mar 17, 04 15:31
Post #4 of 25 (1359 views)
Re: Blood Test Results from IMNZ: Post Race. [taku]
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Funny, you figure that this thread would get a lot of interest. A guy who just did an Ironman posted some really interesting numbers on what went on inside of his body on race day. I'm not a doc or from the medical world (I am an electrical engineer who now does marketing for a living), but as a long time Ironman athlete, this stuff is of high interest. Forget about Bush, Becca, tri newbies riding on steep bikes, or even Bjorn's Chris Boardman like position (and Boardman gets the credit for originating that position...). I was amazed by how Tom could be that dehydrated (I think he said that he lost 10 lbs) and still have normal blood sodium and potassium numbers. Tom, can you repost your nutrition from the day with approximate amounts of Na and K consumed over the 11 hours.
taku
Mar 17, 04 15:37
Post #5 of 25 (1344 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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" I was amazed by how Tom could be that dehydrated (I think he said that he lost 10 lbs) and still have normal blood sodium and potassium numbers."
The kidneys are the most complicated and amazing organs in the body
ajfranke
Mar 17, 04 15:48
Post #6 of 25 (1315 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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I do have a lot of interest, but sadly, very little knowledge of this subject. A little more description of what these numbers mean would be appreciated.
____
This forum is going to be a place of civil discourse, and those who wish to foment hate and discord are no longer welcome here. -- slowman 11/8/04
Art Franke
ssn759co
Mar 17, 04 15:49
Post #7 of 25 (1314 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Tom, did you get a post-race IV? I had a similar dehydration in Taupo for the 2000 race (I think I lost about 12 lbs) but no matter how much I whined while lying on a cot, they wouldn't give me an IV! Had to climb out of that dehydration hell hole with hot soup ... and of course great Kiwi beer much later in the evening. It was probably the right thing to do from a medical standpoint but I know at Kona all you have to do to get an IV is mumble something about throwing up and feeling faint. But they did have a shortage of MDs there that year -- I had a buddy who was actually in a very very bad sort and he didn't get treated for at least a couple of hours.
just jack
Mar 17, 04 16:13
Post #8 of 25 (1272 views)
Re: Blood Test Results from IMNZ: Post Race. [ajfranke]
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Agreed, I'm very interested in the physio side .... much more so than who's riding what and how. But ... I is just a dumb cop who be to stoopid to know what the numbers mean.
*****
"In case of flood climb to safety"
formerly .... jcurtis
DocScott
Mar 17, 04 16:22
Post #9 of 25 (1246 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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As a doc doing some sports med and racing (if you call it that) ironmans including last year's scorcher in Madison(wonder what my labs were at the finish line, given that I didn't have a lot of blood pressure left prior to the IVs), I can say there's nothing (fortunately) exciting about your #s: basically the story is that you probably have healthy kidneys that can tolerate some dehydration without doing interesting and dangerous things to your blood chemistry. That's good news! The human body is a wonderful thing if you're: 1. lucky(i.e. blessed with good health) and 2. take care of it as you get older(the latter is what fascinates me about doing these as I approach my first mailing from AARP)
Geoff
Mar 17, 04 16:58
Post #10 of 25 (1204 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Tom,
Here are my numbers from the same study. They seem to be very similiar to yours, but I only lost 1.5kg.
Serum sodium concentration 141 mmol/L (136 -146)
Serum potassium concentration 5.2 mmol/L (3.5 - 5.0)
Serum urea concentration 12.5 mmol/L (2.7 – 7.8)
Serum creatinine concentration 0.12 mmol/L (0.05 – 0.11)
Weight at registration 84.8
Weight post race 82.9
Weight change -1.9
% weight change -2.2%
I felt good at the finish and had a fairly quick recovery. My time (10:15) was within 1 minute of my fastest IMNZ even with the longer T1.
(This post was
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by Grover on Mar 17, 04 17:00)
devashish_paul
Mar 17, 04 17:14
Post #11 of 25 (1177 views)
Re: Blood Test Results from IMNZ: Post Race. [ssn759co]
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ssn759co, there is a reason why they would not give you an IV. I belive doctor Tim Noakes was working at IMNZ back then. He is also the head doc of the 90K Comrades ultra marathon in South Africa. His whole view, seems to be that it is almost impossible for someone to die from dehydration, but anyone can easily die from overhydration. Both these races have a 100% success rate of treating in the med tent without IV. In many races, with GPs working the "tent", the docs treat people for dehydration when they may have suffered from overhydration.
At IMUSA LP 2003, I ended the race 10 lbs over my normal 140 lbs due to hyponatremia (too long a story to explain how I got there on this forum), but then the docs in the med tent treated me for dehydration and pumped me up with 4.5 more IVs ballooning me up to 160 lbs. The good news is that I survived but I had some seroius post event issues including a full brain concussion and several cognitive items that really did not need to happen, if they just covered me up with a warm blanket, lifted up my legs and orally administered salt tabs and some solid salty food. Fortunately in this case, I did not die from brain stem hernation (which can happen in severe cases of hyponatremia). My neuro specialists told me that I would have a full recovery, even though I still have many post concussion symptoms that seem to be taking forever to clear up. 8 months later, I am just getting back into doing some run training now that the nerves in the head are less sensitive to jarring. Trust me, less IVs are a good thing based on my experience. Luckily, I have been able to swim, ride and XC ski since these sports involve no jarring.
boothrand
Mar 17, 04 17:20
Post #12 of 25 (1164 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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[url]http://www.brinkzone.com/itsinyourblood.html[/url]
<a href=http://www.brinkzone.com/itsinyourblood.html>Primer On Standard Blood Work</a>
Click the link above. A down and dirty primer for everything you mentioned by the Brinkzone guy.
(This post was
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by boothrand on Mar 17, 04 17:21)
DocScott
Mar 17, 04 17:32
Post #13 of 25 (1138 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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agree with the comments on IVs: first rule of medicine = do no harm. in this regard it means don't give dilute IV fluids to people who are overhydrated and hyponatremic(classic cases are people who tried to hydrate a lot, may have overdone it, hot weather, feel bloated and are somewhat/a lot our of it but don't "look" dry); second rule = don't do unecessary stuff, i.e. most people who look and feel a little bit crummy at the finish line do fine with the basic approaches outlined above without IVs
ssn759co
Mar 17, 04 17:37
Post #14 of 25 (1128 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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Thanks Paul. Yeah, I'm not an MD but I would agree that a lot more people suffer from over-hydrating effects than dehydration (especially the type of person that say, does a 6 hour marathon after little or no training and gulps down 2 cups of gatorade every mile because they think it's the right thing to do). And the weight measurement they do at IM NZ would help prevent what happened to you at Placid. Come to think of it, at IM CDA 2003, they made a big deal of weighing everyone when picking up your number, but then I saw no evidence of weighing people after the race (which is too bad, because that race looked like the Bataan Death March because of the dry heat/wind)... unfortunately, unlike IMNZ, the dehydration effects hit me hard about 1 mile into the run. That was the nastiest, ugliest, gut wrenching run/walk I have ever had -- and I got to share the experience with a lot of other people (Mr. De Soto for one)
docfuel
Mar 17, 04 18:03
Post #15 of 25 (1102 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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I agree whole heartedly.
IV rehydration is not indicated for anyone who is able to drink and is not in shock
(dangerously low blood pressure). Most of the IV hydration used in endurance races is totally unnecessary. Oral rehydration is just as effective for almost everyone else. Overhydration and hyponatremia are the big dangers. Hyponatremia (low sodium levels) are primarily from replacing salty fluid loss (like sweat) with water or very low sodium fluids. Overhydration is primarily from excessive and unnecessary IV fluid. Both of these can cause seizures and/or brain swellling. The sports medicine journals are rife (sp?) with articles and editorials on the dangers of hyponatremia and overhydration.
It is very difficult to overhydrate with oral fluids.
In some sports medicine studies. A large percentage (it may have been most) of the endurance athletes diagnosed with hyperthermia or dehydration actually were dangerously hyponatremic.
In WWII the military had a bunch of soldiers running around in the California desert, without fluid, to the point of dehydration. When they became excessively dehydrated, they sat down and were unable to continue. With the ingestion of even small amounts of fluid, they were able to continue.
_________________
Dick
Take everything I say with a grain of salt. I know nothing.
devashish_paul
Mar 17, 04 18:33
Post #16 of 25 (1061 views)
Re: Blood Test Results from IMNZ: Post Race. [docfuel]
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Thanks docfuel. I am familiar with that WWII study and have been in contact with Tim Noakes who has educated me on this topic. To SSN, they did weigh me before Ironman Lake Placid at 140 and then they DID weigh me after at 150. I clearly remember seeing "150" on the scale and immediatley told the med staff that I had gained 10 lbs and felt that I must have been hyponatremic. Unfortunately I did not know what the treatment was (being a non medical person) and did not refuse the IV. I thought the IV must have been some super saline solution that would get my Na concentration back up, so I thought at the time that this must be OK. As it turns out, there is an additional danger in overcorrecting hyponatremia with hyerptonic saline solution too quickly and it is known as central pontine mylinolysis. This is when (in layman's terms), the mylene around the nerves "delaminates" much like the insulation around an electrical wire, causing temporary and in bad cases permanent nerve damage to critical nerves in the brain. Not good. Fortunately, as my neuro guys figured out, this was not my case...a good thing.
Bottom line, be aware of what is going on inside your body, learn what the numbers mean and if you are coherent, refuse IVs at Ironmans. They are largely unneccessary. Oral rehydration and ingestion is the safest way to go :-)
taku
Mar 17, 04 19:24
Post #17 of 25 (1013 views)
Re: Blood Test Results from IMNZ: Post Race. [docfuel]
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I was looking at the orientation packet I got for medical volunteering for ralf's half ironman a while ago... they specifically state that first line is always attempt oral hydration... I could not go to ralph's last year but in the packet they talked about a portable machine that could do blood chemistry analysis... which is a good thing considering the seriousness of electrolyte abnormalities that can be induced with IV hydration...
With IVs I always liked what my mentor would say... "if a person is hydrated enough to get an IV in, they probably don't need it" Very much a truism...
All this talk abotu dilutional hyponatremia has been a hot topic in the last couple of years with the popularity of endurance sports with the public in general... I think the thing that gets left out of these conversations are the people with dilutional hyponatremia are the people who tend to be slower, stay on the course longer, drink more WATER or other hypotonic solutions, and are able to absorb mroe of the water. The reason that this is such a hot topic is that
1 dilutional hyponatremia outside of endurance sports is relatively uncommon, used to be seen in the setting of psychogenic polydipsia
2. It is very serious
3. The initial presentation of hypernatremi and hyponatremia is often every similar.
Becuase there has been so much press in the medical literature about this lately you are going to see a much more conservative approach in the medical tent in the near future at the longer events.
Just as a though I would imagine that these researchers were perhaps looking for a correlation between finishing times and signs of dilutional hyponatremia... this could actually serve as a way to set up guidelines for treatment in the medical tent... just a thought.
Mr. Cleetus
Mar 17, 04 20:19
Post #18 of 25 (968 views)
Re: Blood Test Results from IMNZ: Post Race. [docfuel]
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Just curious for any thoughts on my situation - I was supposed to have this blood test done in Taupo, but did not as I was laid up in the medical tent.
I made it to the finish, but with much walking due to my hands falling asleep, being rather dizzy and feeling pretty nauseated. This all started at 15km into the marathon - about 8 hours into it.
Straight to the med tent after finishing - I lost about 3.4kgs. They watched me (v. low blood pressure, dont remember numbers) and said, as did others, just normal dehydrations signs. 30 mins later up came 2 litres of fluid from my gut, still nauseated, and 30 mins later another chuck. Then over to another tent for 2 litres of drip in my arm.
Unfortunately they forgot to check my electrolyte values. Anyway, not the first time this has happened. I have experimented heaps with food (never happens in training) and I don't even really have a clue what is happening.
Thanks,
Matt
Blockhead
Mar 17, 04 22:49
Post #19 of 25 (918 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Was your weight done on the exact same, calibrated scale both pre and post race?
jTenniswood
Mar 18, 04 2:43
Post #20 of 25 (865 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Thankyou Tom for another great post. This has been a topic of great concern to me as of lately. I have been expiramenting with my mineral intake during long bouts of training. This thread hit the nail on the head.
Any suggestions for products that are available and any personal expiriences (good or bad) would be greatly appreciated. I am doing St Croix and Florida 1/2 this May so heat and electrolyte loss is a large concern.
JT
Titan
Mar 18, 04 5:08
Post #21 of 25 (807 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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devashish paul summed it up nicely: congratulations, you probably did a good job with your electrolyte replacement. Of course blood values and intracellular values don't always reflect one another's relative concentrations of electrolytes....THAT...the intracellular concentrations of electrolytes, is the harder nut to crack. You probably just needed MORE of whatever it was you were doing in order to keep your
total
fluid level up. Good job.
PS, you did take your NSAIDS after all the warnings, didn't you? I hope that playing with the fire of doing that never fries your beans!
Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)
hansoa
Mar 18, 04 7:05
Post #22 of 25 (700 views)
Re: Blood Test Results from IMNZ: Post Race. [Tom Demerly]
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Tom this is a very insightful thread. I was wondering if you could give us a little info on your prerace prep for hidration and food intake. I have yet to do my IM yet as for that is the plan in 2005. I am sitting here with my leg in a leg immobilizor due to cap tracking problems.
Do you think that dehydration was your only problem on bonking on the run portion, or was it something else? How do we order from your store? I have nothing around here and I am highly impressed with your insight and willingness to devulge vast amounts info. Thank you.
HowlinKatTribe
Mar 18, 04 7:59
Post #23 of 25 (639 views)
Re: Blood Test Results from IMNZ: Post Race. [devashish paul]
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How did he feel after the IMNZ? I am attempting my first Ironman, Wisonsin this year and interested in feedback on eating and drinking particularly on the bike part and what has worked for the experienced Ironmen out there.
thanks
jonathan
------------------------------------------------
Trying to find ways to pass the time.
Tom Demerly
Mar 18, 04 8:11
Post #24 of 25 (619 views)
Re: Blood Test Results from IMNZ: Post Race. [hansoa]
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Hey guys,
First off, for the medical profession posters: Thank you for your insight into my numbers posted here.
Here is my analysis, but bear in mind my understanding of these matters is strictly as an endurance athlete with only some medical emergency training (I held an EMT certificate once).
My primary problem was dehydration- quite obviously. I think that was a result of lower environmental temperatures sort of "lulling" me into a sense that I didn't need the fluids. As a result, my fluid intake was moderate to low. I drank about 5-6 large bottles on the bike and several cups at every run aid station. In my opinion, there needed to be two more aid stations on the run.
There was a subtle conspiracy of envrironmental factors converging in Taupo on March 6th. The day started quite cool and the winds were stiff. By late afternoon it was warm but not hot. My guess is it made it to nearly 70 degrees fahrenheit.
In the early morning, damp and misty "Middle Earth" weather the need for fluids did not seem aparent. I made myself drink on the bike knowing I was drinking for seven hours later. But ultimately, I think I fell behind the hydration curve.
Another thing I thought was interesting was the lowish sodium (Na) and the high potassium (K). I needed to take a few more Endurolytes during the last part of the bike and the early stages of the run, with a little more water. That may have helped all the way around.
Beyond that, I think everything went OK.
taku
Mar 18, 04 10:44
Post #25 of 25 (509 views)
Re: Blood Test Results from IMNZ: Post Race. [yaquicarbo]
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Hey yaqui... Gotta disagree with you on this one...
Osmosis is the rule of land when it comes to electolyte and fluids. Kinda like gravity... no way around this one.
Osmolarity of intracellular and extracellular fluids are alwas going to be identical. It is well understood what effect extracellular fluid electrolyte changes will do to intracellular fluids...
What I think you may be referring to is fluid shifts between compartments ie. intravascular, interstitial, etc. That is not as easy to differentiate right off the bat.
I think the take home leson is that too little fluids bad, too much fuid bad...
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