Could this have been a hydration issue?

[MJ H]

Last year at the end of May, I went for an ambitiously-paced (for me) hike of the Allegheny Front Trail, a 40 mile loop. My plan was to do ten miles the first day (starting in the afternoon), 20+ (as long as I could go) the second, and finish the remaining ten or less on the third. The longest I’d even done in a day prior was 15 miles or so, but there were cross trails and road walks so I knew I could shorten it if I needed.

The first day went fine. The second day, at about three the afternoon after about 17 miles, I stopped to rest because of exhaustion. I could not recover my breath. After I about an hour, I decided I’d better stay for the night. I didn’t feel like the hour of rest had helped me recover at all, I was at the last camp site before a long climb, and I was about three mile from the next promising place to stop.

It was a warm, muggy day with a high over 80 and intermittent rain for the afternoon. It was really the first such day of the season for me. With even moderate exertion, I was sweating profusely. Water was abundant, cold, and clear, so I had been drinking a lot. But, despite never being thirsty for longer than five minutes, I didn’t urinate all afternoon or evening. I ate dinner and went to sleep as soon as it was dark. I found myself waking up to urinate three or four times before midnight. Not old-man-prostrate-urination, but six-pack-of-Yuengling-right-before-bed urination. I slept until the sun came up and woke feeling great and walked back to the car without issue (maybe 8 or 9 miles as I took a short cut, not wanting to risk boinking a couple of miles short of my car).

At the time, I thought that I had just out-walked my cardiovascular system, but I’ve been wondering if I wasn’t somehow handling hydration wrong. Is this the kind of thing that electrolyte drinks help with? Maybe I was boinked because even though I had enough water, it wasn’t getting to where it needed to go?

[Matthew / BPL]

Maybe hypanutremia? Where you eating during the day?

[MJ H]

I don’t think it was low sodium. For breakfast, I had oatmeal. I probably had some kind of snack along the way (Cliff Bar?). But I had a Mountain House for lunch and dinner. Lunch was a one serving sample I got from REI or somebody as a freebie. Dinner, which was eaten after I’d stopped, was a ProPak. I don’t recall which ones, but I don’t think any are low sodium.

[Lester Moore]

YMMV, but I find that I need to purposefully increase my sodium intake for long days, especially long hot days, even if I drink plenty of water. Adding lots of salt to salted nuts and to any home-made stuff (dried kale, sandwich, etc). When I add sodium to foods I have much fewer problems with cramps at the end of the day and while sleeping that night. Taking a packet of Emergen-C before bed seems to help some too.

One of my hiking partners got hyponatremia once after a very long, warm day of backpacking. She was exhausted, could not catch her breath and had to stop and rest. She went from looking fine to having to stop in less than an hour. After quizzing her she did not have nearly enough salted foods and did nothing to supplement sodium or other electrolytes that day. After eating the dregs from the bottom of my salted nuts she recovered quite quickly and hiked the last 3 or 4 miles out just fine.

[Rob P]

I had something similar happen to me last year on a backpacking trip, so I’d be curious to hear from those with medical expertise.

I was thinking for future trips that I would try to limit sugar in case the excessive urination was some type of insulin response.  I was eating enough salt, so I found an electrolyte powder that is heavier on the potassium than sodium, and is sweetened with stevia….I was thinking about trying that in case the issue was a potassium/sodium balance issue.  However, I’m just guessing because I have no medical expertise.

Too much protein?  Too much advil?  Just guessing here…..

[Tom K]

On extended hikes, or at altitude, I routinely add 1/4 tsp of plain table salt to each liter of water I use, and drink enough to pee clear every hour or so.  That said, your symptoms sound more like mild hyperthermia to me.  Under hot, muggy conditions, your body is less able to cool itself by evaporation, and your core temperature can insidiously rise to dangerous levels, even though you are sweating profusely.  The fact that you didn’t urinate all afternoon and evening indicates that even though you were drinking, it was not enough to replace the water you lost as your body desperately tried to cool itself in the only way it knew how.  You were wise to stop when you did, eat, drink, rest, and give your body a chance to rehydrate and cool down.  It may have saved your life.  Once hyperthermia sets in, decision making is impaired and there is an atavistic tendency to push on that often ends in tragedy.  I know of two incidents where gifted athletes pushed on in similar circumstances and very nearly paid with their lives, and have had two such experiences myself while running a trail marathon at altitude and a 50 miler, both in hot weather.   You dodged a bullet, MJH, by making a very wise decision before your judgment was overly impaired.  Learn from the experience and adjust your hiking pace and distance accordingly.  One other comment:  Attempting a distance longer than any you had previously attempted under such difficult conditions was the initial error.  In future, best to try to extend your distance under more favorable conditions. 

[MJ H]

Thanks Tom. I’ve been reading those symptoms and I think you must be right. I didn’t consider it at the time because I never felt overheated or nauseous and because I had unlimited water. I hadn’t considered that fatigue itself could be a symptom of heat stress. In retrospect, I think I should have jumped into the water or soaked a towel in it and wrapped my head.

(I don’t think I was at any considerably elevated risk of mortality. I intentionally picked a trail with lots of potential exits points and I had a cell phone with a signal and was a couple of miles from a road.)

[Rob P]

Is excessive urination a sign of heat stress?  I know that on the trip where this happened to me, it was high 40’s (F) in the daytime and mid 20’s (F) at night.

[MJ H]

I assume the excess urination was a trailing indicator of heat stress. That is, after the stress had passed, the kidneys made up for lost time.

[Tom K]

“(I don’t think I was at any considerably elevated risk of mortality. I intentionally picked a trail with lots of potential exits points and I had a cell phone with a signal and was a couple of miles from a road.)”

I agree.  Your condition clearly hadn’t progressed to that stage.  Had you pushed on, it might have been a different outcome.  In that case, a cell phone and proximity to a road would not have done you much good.  In any case, all’s well that ends well.  You made the right call, came out in good shape, and learned a valuable lesson.  Such is human progress.  ;0)

 

 

 

[Roger Caffin]

With that amount of medical upset, you may simply have been fighting a virus of some sort. So often at home we ignore them.

Regardless, you had escape options and used them wisely.

Cheers

[MJ H]

It wouldn’t be the first time not wanting to go somewhere saved me.

[Franco Darioli]

Cutting the trip short was a good decision particularly because you were by yourself.

[MJ H]

With that amount of medical upset, you may simply have been fighting a virus of some sort.

It didn’t feel like the same kind of tired as when I know I’m fighting a virus, but then I don’t really have much chance to know what it feels like to fight a virus if it is one with symptoms too mild to show up until I’ve done a dozen miles.

I think I’m just going to make a mental note to stop if, after a half hour of resting, my pulse doesn’t drop back below 100 or so. And maybe jump in the creek if I can find a hole.

Thanks all for the advice.

[Roger Caffin]

And maybe jump in the creek if I can find a hole.
Oh, highly recommended!

Mid-summer, and I needed that!

Cheers

[John S.]

nm

[Roger Caffin]

I could not recover my breath.
I had another thought about this.
It can mean you were suffering from heat stroke.

This is a REALLY wierd problem: really, really wierd. If you are panting like mad and feel you cannot get enough air (on a hot day), then the correct response is the exact opposite (as it were) to what you might think. STOP panting, STOP trying to suck in more air, get in the shade, drink some water if you can, and REST very still.

I agree entirely that stopping panting is extremely difficult to do – but it is also just about the only thing which works. Keep panting for too long and you can do yourself a nasty.

What has happened is that the normal feedback loops in your body have got themselves tangled. You THINK you are dying from lack of oxygen, but that is not true. Your internal feedback signals have gone all wrong. When you pant for air, you are further stressing your heart and lungs, getting even hotter, and making your condition worse.

The biggest problem is actually recognising the problem in yourself, and taking action. I have had to coach someone for about 15 minutes into ‘slowing down’ before they suddenly started to snap out of it. Then they were OK.

After a few rounds of heat stress, verging into heat stroke (two different medical conditions), you do get to recognise the symptoms. We get a bit of it here in Australia.

Cheers

[MJ H]

“Recover my breath” was not a well-chosen phrase on my part. I was using “breath” as a signifier for overall exhaustion and not the leading symptom. I was breathing heavily, but the main thing I noticed was the heart pounding and racing. I don’t think my heart would have let me move fast enough that I had to pant.

More generally, since this I have been looking at the signs of heat stroke and heat exhaustion (because I clearly forgot them). I think heat exhaustion seems to be the better fit as, according to Dr. Wikipedia, you need to have a significantly elevated temperature and a lack of sweating. I don’t really know what my temperature was, but I never stopped sweating until I had been seated in the shade for a good long time.

I agree it is hard to recognize. I didn’t even consider it before Tom suggested it and in retrospect is seems obvious.

[Roger Caffin]

Learning, learning, learning.

Cheers

[jscott]

“but the main thing I noticed was the heart pounding and racing.”

Tachycardia brought on by….heat, exhaustion, lack of water…altitude…? I wonder how long this went on after you were immobile.

More though; any heart arrhythmia?

Potassium and magnesium are very important for heart functioning. some people can resolve tachycardia or other issues by taking a pretty decent dose of potassium–much more than you’ll get from a sports drink mix. But careful, don’t overdo it!

Flutter is similar to tachycardia but often much more serious. You may want to google “atrial fibrillation” and “flutter”. Most likely this isn’t your issue. But going forward it may be good knowledge to have on hand.

[MJ H]

Tachycardia brought on by….heat, exhaustion, lack of water…altitude…? I wonder how long this went on after you were immobile.

Heat and exhaustion, yes. No altitude problem (I was in Pennsylvania) or lack of water. I don’t know exactly how long my heart rate stayed rapid, but at least an hour after I stopped moving. I sat for a good hour, not moving except to filter some water, and then slowly set up camp once I realized my pulse hadn’t dropped during the hour. After I did that, I was still very tired, but I started to feel hungry, so I suspect my heart was calm my then. I didn’t think to check my pulse again.

I’m open to trying sport-drink levels of potassium (indeed, that kind of thing is why I put the question in this forum). It’s been mentioned above and I quietly resolved to get some kind of powered mix before I go out again in the summer. But I’m not going beyond that kind of concentration without my doctor saying I have a problem and prescribing something. I’ve never been diagnosed with any arrhythmia or other heart condition.

[jscott]

Potassium is essential to the proper electrical functioning of the heart. As you know, it’s an electrolyte and exercise, heat etc. can deplete the body’s store. Sports drinks have a pretty tiny amount of potassium, as do potassium supplements, because there’s a worry of people getting too much potassium in their system, which can be dangerous. But the amount in sports drinks is about equivalent to a banana–maybe less. Strangely, low sodium V8 juice has (is allowed to have?) far more potassium than any sports drink or supplement. A small can gives you about 20% of your daily average. (these are very small cans). So you could drink 5 cans of low sodium V8 and get a daily average of potassium. OR, you can take NoSalt salt substitute, which is very high potassium. 1/4 teaspoon is about 40% of your daily average. If you experience tachycardia–sounds like you did–bolting 1/2 teaspoon or a little more of NoSalt is entirely safe and may well help. The biology is complicated and beyond me, but this is medically legitimate. Of course, I’m just a guy on the internet so you may want to explore this more yourself.

It’s my understanding that no matter what causes tachycardia–heat, exhaustion, etc.–once started you are by definition potassium/magnesium depleted. You need these minerals for the proper electrical functioning of your heart. You want electrolytes and probably more than a package of sports drinks will give you.

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