looks like they had another case of it.

http://www.paddle24seven.com/index.php?option=com_fireboard&Itemid=82&fu...

What I've noticed out here is lack of bananas. They are rich in potassium (hence the name potassium stick) and B vitamins and have more carbs than apples. You can actually mush them up and mix with a dring and take thru a straw or as one paddler I pit crewed for, had soft banana spread on whole wheat bread. Yum! Anyway they are a good food and come  in their own waterproof wrapper ideal for paddling sports.

This is a serious question.  What is wrong with electrolyte pills that you can add to your water?  I have those and use them regularly.  Should I stop and simply focus on foods with high salt content?

If so, how do I calculate how much salt I need?  Plus, how can you tell the difference between dehydration symptoms and hyponatremia symptoms?

The last thing I want is for this to happen to me or my partner during the Freedom Race, or to anyone else for that matter.

Thanks.

Alex

Thanks for the info.  Valuable guidelines.

vitalyte.

Some info posted by a paddler on the Paddle247 forum:

Hyponatremia is a serious medical problem for safari racers. It is not well understood by the Texas racing community. I do not have a lot of training about hyponatremia but I do have first hand, personal experience with this condition that few other people do. When properly educated and prepared hyponatremia is EASY to diagnose and to treat, even on the river during the safari.

But, let me begin at the beginning.

Early in the race I opened my major food pack. The canoe capsized and I lost a fair amount of food. I decided to try and ration my food and see if I could make it to Seadrift. The race was intense and I decided to eat and drink my planned nutrients in the day and to cut back on everything at night. My food plans going into the safari were not well thought out. I was going to save time by consuming calories, hydration, and electrolytes all at one time. My food was packaged in such a way that once it was opened the entire package needed to be dumped into my water jug. I could not put half of it in a jug now and save half of it for later. I had no electrolytes in a separate container.

I felt great at Gonzales. At Gonzales I started drinking plain water and began the process of rationing my food. I had some solid food that might have contained a little bit of electrolytes and my plans were to eat some of the solid food at night with the plain water. After one hour of drinking plain water I felt even better than I had before. It was dark and my solid foods were not that well organized. After two hours of drinking plain water I felt even better. I felt like I was on a high and I absolutely lost all desire to eat. (one of the symptoms of hyponatremia is a complete loss of appetite or desire to eat)

The plan that I had initially formulated in my mind called for me to switch back to a calorie & electrolyte pack at Hocheim. Hyponatremia has a major impact on the brain. I was already beginning to experience hyponatremia and at Hocheim I never bothered to dump a calorie & electrolyte pack into my water jug.

My physical condition was deteriorating rapidly but I was not aware of this. Jerry hollered, “ Are you O.K.” and I replied “Yes”. Later Jerry hollered, “Are you sure you are O.K.” and again I answered “Yes”. I was having a hard time trying to hold my body vertical. I had the muscle strength to hold my body vertical but my brain did not know where vertical was. I kept leaning backwards thinking that vertical was somewhere behind me. I remember bobbing back and forth many, many times but I had absolutely no idea how far backwards I sometimes leaned until much later when someone showed me this photograph. We did not turn over and I somehow pulled myself back to a more vertical (but still leaning backwards) position and I tried to continue paddling.

I paddled past the bridge. Jerry knew something was wrong and he started looking for a gradual river bank where he could paddle the canoe right onto the sloping bank. Finally he found a sloping bank but the ground was a muddy bog. His plan was to get me out of the canoe and try to figure out what was wrong. I saw Jerry get out of the canoe and start to the back of the canoe. I tried to step out of the canoe and I fell down on my face. I could not stand. I really could not talk. I could say yes or no or O.K. but I could not compose a sentence. My vision was getting blurry but my hearing was good. I was very much aware of everything that was happening but I could not make even the simplest decision. I could hear everything people would say to me but it was impossible to understand the significance of what they meant.

Laying in the mud felt so very, very wonderful. I wanted to lay in the mud and go to sleep. Laying down felt so much better than sitting in a canoe. I was not hungry and I was not thirsty but I was tired and I wanted to be left alone to go to sleep. If I had been in a solo boat I would have slept here until I died. Jerry got a life jacket on me and cleaned me up a little bit. He manhandled me to the front of the canoe and got me in the canoe seat. He left his drinking jug in the front of the canoe and he laid his drinking tube across my lap so it would be in easy reach. He paddled me to the next bridge but I never one time made any attempt to drink anything from his jug. I heard Jerry holler, “Roy stop paddling”. But I continued to lift my paddle and tried to take strokes. Later Jerry hollered in a more authorative, louder voice, “Roy stop paddling”. I don’t believe I ever quit trying to paddle.

By some miracle we never turned over and I never fell out of the canoe. At the next bridge my wife and daughter hugged me and asked if I wanted a bite of banana or a drink. I shook my head no. It was getting difficult to give even one word replies like yes or no. They hugged and kissed me but I never made any attempt to kiss them back or show any emotion. The bank was steep and it took several people to carry me to the SUV. I was rushed to the Victoria emergency room and they immediately sent me to ICU.

One funny side note. When they laid me in a bed in ICU I closed my eyes but I still had not gone to sleep. I believe the doctor and my family thought I was in a coma. The doctor told my wife that my condition was very serious and they would not know for a long time whether I would pull through or not. He said that several of the systems in my body were shutting down. One of the biggest concerns were my kidneys. The funny thing was I could clearly hear the words (and later remember them) but it never occurred to me that the doctor was saying I might die. His words did not concern me in the least. When the blood tests and other tests came back the doctor told me that my sodium level was the lowest he had ever seen.

In my next post (probably tomorrow) I will get into how you determine that a racer has hyponatremia as opposed to just being tired and mentally down or dehydrated.

(NEXT POST)

Your body fluids require a fairly precise ratio of sodium (salt) to water in order for the nerves, muscles, and other body processes to work. When the percentage of sodium falls to low then your body sends a signal to all the cells to start absorbing water. Most of the cells can absorb water fairly easily. When the brain cells absorb too much water they expand and because they are constrained by the skull the brain is under considerable pressure. This causes most of the problems with hyponatremia.

Once you understand that hyponatremia is a brain problem it is fairly easy to diagnose. The single most important thing to know about hyponatremia is that you have to be able to diagnose your partner's condition and he has to be able to diagnose your condition. The person that develops this conditions will in most cases not recognize the condition and will make many bad decisions. The easiest way to diagnose hyponatremia is by talking. The person that is developing hyponatremia does not want to talk. They want to give one word answers. They can not use logic. You and your partner & team captain should agree before the races begins to communicate in full sentences and to be descriptive. You might say "O.K. partner keep the boat going straight, I am going to pee. This is only the 3rd time I have peed in the safari and we are already past Gonzales." Your partner will instantly know that your brain is working fine. You could still be dehydrated or have other problems but you do not have hyponatremia. Your partner would be expected to give you similar information. He might say I just finished my 3rd calorie bottle. I was expecting it to last me to Hocheim but it is empty so I am going to eat a little more solid food. You will know your partner is O.K.

Each paddler should be keeping a rough track of how often your partner is peeing. Do not ask your partner a yes or no question. If you suspect that your partner's brain is getting confused you might ask him to give you a recap of how many electrolytes he has been taking and when did he take them. A person with hyponatremia doesn't feel like joking, laughing or talking.

If you are even suspicious that your partner is getting into trouble I would immediately pull over and get out of the canoe. If possible sit your partner down and lean him up against a tree. You might say partner I am worried about you. We agreed to talk in full sentences and you have been acting suspicious. We aren't going anywhere until you eat this salted plum. Depending on your partner's condition he might be able to grab the plum and slowly start eating it or he might just grab the plum and stare at you. You need to take a sip of your partners drinking jug and see what is in it. You need to lift your partner's jug and see how much fluid is in his jug. You might lift your jug and compare the weight of his jug to yours. If your partner is in worse shape than you imagined see if your cell phone is working. Touch your partner's skin and see if it is moist or dry. Can your partner spit?? With a really dry skin and very little ability to spit and a hydration jug that has way to much water in it and a partner that has not peed in a long, long time your partner could just be dehydrated. You will be amazed at how easy it is to get a relatively good indication of your partner's problem.

If your partner refuses to eat the salted plum you might get a small container with a CONCENTRATED solution of electrolytes. Your partner can hear what you are saying and can partially comprehend. Try and help your partner take a few sips of the concentrated electrolyte solution. Do not let any boats paddle by you. Stop them and solicit their help. If your partner is in serious shape you do not want to spend a lot of time on the bank.

If you and your partner are talking there is no reason why you should not detect any potential problem early. The absolute worst thing you can do for a person that has hyponatremia is to give them plain water. If you detect the problem early your partner can eat a salted plum and take some extra electrolytes.

A person that drinks an extra large volume of water during the safari is at a higher risk. If he ever starts to develop hyponatremia his body will send a signal to stop drinking. That person has probably trained himself to drink even when he is not thirsty and he might well ignore the signal to stop drinking. If you drink a large volume of water it might be safer to add a small amount of electrolytes to each drinking jug. The more water you drink the more electrolytes you will take in.

I have switched to a liquid source of electrolytes. It actually improves the taste of the water. I have no experience at consuming this for long periods of time. In the old days there was a product called gookinade. Lots of safari paddlers added this to their hydration jug. I believe the product was later renamed vitalyte. Some people found that problems they had experienced in previous safaris went away when they added gookinade to their drinking water.

It really doesn't matter what your source of electrolytes is as long as you take enough on a regular basis. Your biggest problems will usually begin at night. It is easy to get zoned out and to let the time slip away from you. You also normally talk less at night.

I believe some salted foods would be wonderful. In 2004 Jerry Nunnery showed up at the safari with salted rice balls that he had made. I ate one and it was wonderful. I coveted those rice balls all the way down the river. I believe salted plums would be wonderful. One year I asked Fred Mynar what he ate that really tasted good. He grinned. He had taken a couple of bags of freetos and crushed them so they were in small chips. He started craving salt and he said the freetos tasted really good.

I think lots and lots of safari paddlers have had mild cases of hyponatremia without ever knowing it. One of the symptoms is hallucinations. I am not saying that everyone that has ever hallucinated had a mild case but if you start hallucinating tell your partner. Use this as a warning and take steps to make sure you do not get hyponatremia. In 1979 I raced with Scott McDonald. We had never heard of electrolytes and we did not bring any electrolytes. He drank koolade most of the time. We won first place and someone brought Scott a large glass of tea at the finish. Later I saw Scott walking to the motel room. He was leaning back and he was not vertical. Scott was definitely in the early to moderate stages of hyponatremia. Over the years I have seen several safari finishers do the same thing.

Don't be afraid of the safari. With proper education and planning you can run a safe and successful race. The education will not only include you and your partner but it also has to include your team captain. Your team captain has to have the training to properly assess your health. Your team captain has to have the authority to pause you at any point in the race and to make sure that you do not leave before it is safe. A good team captain will help you to stay healthy and increase your odds of a successful finish. A team captain should know your hydration plans, your electrolyte plans, your calorie plans, etc. He should check every water bottle you turn in BEFORE you leave the check point to see how much you are drinking. If you are a solo paddler you should have a plan on what information you will give your team captain at each check point.

That is a really informative description.  Thanks for posting it here. 

Aboard the safety boats, the coherent, complete sentence test is used a lot.  We ask all our safety pilots to try to engage paddlers visually and verbally.  If we're idling along passing boats we will try to have a brief conversation and make sure you're good.  If we're hustling to get somewhere we're needed we might pass from a distance and just hold up our arm with a thumbs up.  We're hoping you respond with a thumbs up to indicate you are fine. 

At night especially we try to talk to paddlers as we encounter them.  We've had paddlers be "unresponsive" and not acknowledge us.  Never considered it might have been mild hyponatremia.  Just assumed exhaustion.  These instances are often reported by other paddlers who have concerns about someone they passed.  This accounts for many of our calls on safety boats.  "Paddler looks shaky." "Paddler won't talk." 


When we see groups of 2 or more boats paddling together, that's our ideal scenario at night.  There are always conversations and laughter that we can hear from a few hundred yards away.  That's a good way to pass those evil hours of 2am to 5am.  They are the least favorite if you're alone.  Seems like the night will never end and you're in some kind of hell.  But if you're with another boat or 3 or 4, the time goes quicker and you are less apt to start having issues related to lack of alertness.  You also tend to go faster as everyone is trying to keep a good pace so as not to lose the group... this creates an artificial urgency that works well for keeping you warm and awake.

Long story short, we really count on you guys to watch each other.  You will go hours without seeing a safety boat.  But there will be no shortage of fellow paddlers who will gladly help you.  And like the story above, if you are not talking in complete sentences it's a big red flag.

It's simply a matter of "drinking to quench your thirst" instead of following some guideline of 1.2 liters per hour or not drinking enough.

After the tragic death in the Safari, been looking into this and discovered that there has been cases in ultra marathon events where distances between drinking stations have been adjusted to make sure that runner don't over drink. Unfortunately, in many running events, a medical personnel at a first aid station would automatically assume that a runner is dehydrated and immediately start an IV without carefully assessing the symptoms. This would make matters worse.

Di and I did a 4 hour run yesterday as well, choosing to do so at the maximum heat of the day 11-4:30. We kept very careful inventory of fluid, nutrition and calories- even potassium, Calcium and iron.
I hit my sodium and potassium targets with ease using foods/fluids. I was deficient in total calories and water intake. Di used fizz, sipping it at intervals and did well.
You NEED calcium- but a tums will do it. A tums will also counteract stomach acidity.
We were very proud of our performance- we "thought' we did very well, staying totally comfortable and fresh....except, on the way home we drank a half gallon of H20 and we didn't even think about supper. NOt good.
Post effects of heat exhaustion is next day lethargy, tiredness and laziness (which I have today) Di has a little lethargy.
Headache....that's serious in my book. That's increased heart rate, blood pressure, and/or cellular edema. Could be stroke- could be Hyponatremia....you have to inventory what have you done in the past hour?
Stomach ache.....okay, think about this, what is your body trying to tell you? Something in your stomach is wrong. Period. It could be too much water, in which case a whole cascade of hormonal activity is being put in motion leading to cellular edema and Hyponatremia. In wilderness first aid this is under the category of Screwed with a capital F.
It could be too much salt and electrolytes, which drinking MORE pure water might cure.
If this starts getting out of hand, my solution is purge. Stick your finger down your throat and start over. Starting over is tricky as you have to be fairly certain what the problem was- too much water- or too much electrolyte.
Take your time, add slowly (why I don't like electrolyte pills.)
The  sodium within your cells, by weight, does not change. That's your body's homeostasis. What changes is outside of your cells and depends almost totally on what YOU do. There is no set formula, but there are "ranges" which you can use.
That's why I urge over and over- understand osmolality. Know what's going in with your food and drink.
Next time I will add 2 "fusion" cans and meet all my range criteria.
For the 340 I will have race packets with exactly what I need between checkpoints. Di actually labels boxes with the checkpoint where she gets that box...good idea!

GROUND CREWS TAKE HEED: What Scott posted applies to us as well. If your paddler(s) are acting flaky and not responding appropriately at a check point-DO NOT LET THEM LEAVE! No race or accomplishment is as important as returning home safely! I strongly advise all to read up over the next 4 weeks about electolytes and fluid replacement. The research is out there and it could save your lives.

www.cwu.edu/~geed/446/fluids.ppt

http://www.athleteinme.com/ArticleView.aspx?id=256

By the way, I plan on doing a thesis on just this subject, so I am planning on documenting as much as I can on jsut this subject. If any of you folks would like to share what you do and the outcomes let me know. I can find little to no true research on marathon paddling; most of the research i found so far pertains to runners and bikers.

Be safe, and as always we are ready & willing to help with emergent medical issues.