1. Finding the Balance Case Study 1: The Ironman Triathlete

2. Patient History
Your patient is competing in the yearly Ironman Triathlon Race in Hawaii. They have spent the previous year training for the event, but this is still their first event of such long distances (swim: 2.4miles, bike: 112miles, run: 26.2miles). Afternoon temperatures hover around 85 F with a cloudless sky. It is hour 10 into the grueling race and your patient collapses 200m short of the finish line. He attempts to get up, but falls right over again. He is able to finish the race by crawling on his hands and knees. Upon completion of the race, he is immediately taken to medical professionals. 2

3. Hospital Admission Form
Patient Name: Scott Williamson Gender: Male
D.O.B: 10/13/ Age: 28
Height: 5’ Weight: 150lbs
Temperature: 99.9 F HR: 150 bpm RR: 45bpm
Blood Oxygen: 95 Blood Glucose: 50mg/dL Blood Pressure: 90/75 mm/Hg
Blood Sodium Level: 125 mmol/L Magnesium Level: .50 mmol/L
Normal Levels: mmol/L Normal Levels: mmol/L
Patient History: Family History:
Tobacco Use: No Diabetes: No
Recreational Drug Use: No Liver Disease: No
Sexually Active: No Heart Disease: No
Current Medications: None Lung Disease: No
Cancer: No
Hypertension: No
Mental Illness: No 3

4. Things to look for
What are the discrepancies between what is ideal and your patient's current condition?
What can those discrepancies tell you?
What clues in the patient's history might indicate a recent change?
What feedback from your patient's body was ignored?

5. Iron Man Information -Crazy Caloric facts from Ironmans
-Calories burned around 8,000-10,000
-700 calories burned per hour
-The body is able to store around 2000 calories in the form of glycogen
- Your body can only absorb 350 calories per hour
-How quickly do you enter a calorie deficit zone?
[Reminder: the Iron man goes for over 10 hours]

6. Major Electrolytes 6

7. Electrolyte/Hydration Case Study
9/19/13

8. What is going on with this patient
What is going on with this patient? How do we treat it and what do we recommend for prevention? 8

9. Hitting the Wall
Hyponatremia- when blood sodium level falls much below normal (136 mmol/L) The typical symptoms include: headache, muscle cramps, weakness, disorientation, apathy and lethargy.
Exercise Associated Muscle Cramps (EAMC)
Exercise Associated Muscle Cramps (EAMC) is defined as cramping (painful muscle spasms) during or immediately following exercise. Muscle cramps during exercise are very common, even in elite athletes. They can occur during or after repetitive exercise performed in the heat, cold, or in water. Cramps tend to be more common and severe when intense exercise is done in hot and humid environments

10. Cellular Nutrition and Waste
Metabolism
Metabolism is the rate at which cells of your body consume oxygen and nutrition. The increased demand of muscle cells for oxygen and nutrients during exercise is a state of increased metabolism. Homeostasis is maintained when your heart can provide the rate of blood flow necessary to meet your body's increased metabolic demand for oxygen and nutrients.
Cellular Nutrition and Waste
Exercise increases the production of cellular wastes such as carbon dioxide and lactic acid. Your cardiovascular system maintains homeostasis between the delivery of oxygen and nutrients and the removal of cellular wastes by increasing your heart rate. Your increased heart rate speeds up delivery of oxygen and nutrient rich blood to your musculoskeletal system while increasing the rate at which blood is taken away from tissues and delivered to the lungs to receive oxygen. 10

11. Electrolytes
An electrolyte is a compound that ionizes (loses/gains an electron) when dissolved in suitable ionizing solvents such as water. Electrolyte solutions are normally formed when a salt is placed into a solvent such as water.
Electrolytes are important because they are what cells (especially nerve, heart, muscle) use to maintain voltages across their cell membranes and to carry electrical impulses (nerve impulses, muscle contractions) across themselves and to other cells. Kidneys work to keep the electrolyte concentrations in blood constant despite changes in your body. For example, during heavy exercise, electrolytes are lost in sweat, particularly sodium and potassium. 11

12. Dehydration Hypoglycemia
Dehydration occurs when you lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. Many athletes, like triathletes will drink too little water and suffer dehydration. The athlete's body usually cannot absorb water from the stomach as fast as it is sweated out. Severe dehydration can cause low blood pressure
Hypoglycemia
Hypoglycemia, or low-blood sugar, occurs when blood glucose levels drop below normal, which is 70 mg/dL. When this occurs, you may become shaky, nervous, confused, dizzy or light-headed and weak or have trouble speaking. Hypoglycemia can occur in anyone and is often an issue in individuals who exercise longer than one hour. Athletes who fail to eat and drink sufficient carbohydrates before and during an event are at risk. 12

13. Prevention Ideas
-Acclimate- train in conditions similar to where you will be competing, so your body can adapt (factors: altitude, heat…) Temperature regulation- wear breathable fabrics while exercising, to promote sweating
-Balance your electrolyte intake- consume supplemental salt or electrolytes during the event. Most sports drinks have sodium levels that are fine for shorter distances, but inadequate for longer distances.
-As always, you need to drink. Don't wait until you are thirsty; the human thirst mechanism is too slow. 13