May 21, 2015 • Sports Medicine

The risks of overhydrating

Football coaches will hear a lot leading up to summer practices about how to keep athletes safe in the sweltering heat.

That places an emphasis on hydration, but even water consumption can pose risks.

overhydrationWater intoxication, or hyponatremia, doesn’t receive the same attention as heat-related illnesses, but it’s still something coaches should be aware of. Summer practices can be brutal beneath the midday sun, but there is such a thing as too much water.

“Hopefully, schools are prioritizing and getting coaches and volunteers the appropriate education,” said Dan Reznichek, physical therapist with Aurora BayCare Sports Medicine in Wisconsin. The majority of high schools across the nation do not have full-time athletic trainers, so coaches should be capable of identifying symptoms of hyponatremia.

“They should reach out to see what’s available for them to learn about a lot of these topics in terms of heat exhaustion, concussions and other injuries.”

Water intoxication became a topic of discussion last August, when Georgia high school football player Zyrees Oliver died in the days following one of his practices. Reports indicated Oliver consumed two gallons of water and another two gallons of sports drinks to get rid of his cramps. That resulted in a chain reaction that caused his brain to swell.

Hyponatremia isn’t common, but it’s still an illness that coaches must be aware of, especially in the summer months when athletes are encouraged to consume water regularly during workouts.

Reznichek said hyponatremia cases in his area of Wisconsin are limited to about one each year, typically coming during triathlons or other endurance sports. Team sports athletes can fall victim to the illness, but it’s more of a risk in southern states where summer practice temperatures can eclipse 90 degrees.

Identifying it can be tricky, especially when the symptoms might give the impression the athlete is suffering from something else. Reznichek said hyponatremia at a mild stage could result in a decrease in performance, but as the athlete’s health deteriorates they could experience headaches, lethargy, nausea, swelling of the hands or feet, and vomiting. If untreated, it could lead to loss of consciousness, seizures or death.

“A lot of these signs and symptoms, when taken in isolation, could be taken as symptoms of other problems like a concussion,” Reznichek said. “I could see how it’s a challenge for sports medicine teams. And one of the things that makes this unique compared to other heat illnesses is the athlete would have a relatively normal body temperature.”

The illness strikes at the cellular level, Reznichek said. The athlete develops an electrolyte imbalance — the more water that’s consumed, the more it dilutes the levels of sodium in the body. It’s already a challenge keeping athletes properly hydrated, because the more they sweat the more sodium they lose.

Reznichek said a common mistake athletes and coaches make during long practices or games is they replace the body with water but not sodium. That’s where sports drinks become an essential part of keeping athletes healthy and strong.

“It contributes to the imbalance when you lose sodium but add water and that scale keeps tipping,” Reznichek said. “That’s where things can accelerate and they start to develop those symptoms.”

If coaches do suspect something is wrong with an athlete, it’s crucial to immediately remove them from play. Reznichek recommends moving them to a shaded environment to help them properly rehydrate, preferably with a sports drink. In cases where they’re experiencing more severe symptoms, it’s best to seek advanced medical assistance.

Not having an athletic trainer on site can make matters difficult, but not impossible to manage. The National Athletic Trainers’ Association offers numerous resources for coaches on everything from heat stroke to hydration issues, and Reznichek recommends that all coaches educate themselves, regardless of whether they have an athletic trainer on hand.

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