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Hypokalemia, Hyponatremia and Endurance events (Running, Inline Skating, Cycling)

kjg's picture
As many of you are already aware at the end of this years A2A I paid a visit to the ER. The symptoms and diagnosis were something that I was not previously familiar with and I wanted to share my memories in the hope that you might recognise them in yourself or someone else in the future.
It took us longer than expected to skate from Athens to Atlanta for a number of reasons. These are not meant as excuses or complaints just background. One of our team become severely dehydrated when one of the rest stops was further away than expected, we skated portions without water when water stations were not there and I ran out of Gatorade due to a confusion at one of the rest stops. But despite all this (and a disappointment every time I looked at my watch ;-) ) I was feeling o.k as we rolled the final long miles into Atlanta. Tired but o.k!
My first clue that something was wrong (in retrospect) should have been a sudden and urgent need to pee write before crossing the pavement. I stopped at a dubious Greek restaurant. I had downed two bottles of water at both of the last two rest stops and had stopped eating after the last rest stop (in my delusion thinking I didn't need to eat because I was nearly done.)
I skated to the finish and still felt good. I called my husband about 30 mins after finishing to tell him we had made it and realised that I wasn't making a lot of sense and couldn't really think straight (talking in a baby voice) - Symptom 2! But I put this down to exhaustion. I started feeling worse - most easily described as "spacey" and thankfully told a friend who was supporting us. This was my first smart move! Over the next 45 mins or so (my memory is a little fuzzy) I deteriorated gradually. Basically acting and feeling as if I was very drunk. Not speaking coherently, making clicking/whirring noises (Blake and Elizabeth can probably fill in some blanks here!)
In an effort to help I drank two more bottles or water, one with electrolyte mix and the second with a salt packet but was obviously getting worse. I peed maybe three more times during this time. I thin it was at this point that Blake mentioned the possibility of Hyponatremia which I had read about in a runner's magazine (a fact that I insisted on telling everyone in the ambulance and hospital for fear (in my drunkard state) that they would not know about it and pump me full of more fluids and kill me for sure! So I stopped drinking water but still wasn't feeling any better. I eventually requested an ambulance (which seemed to take forever to arrive) and was taken to hospital. They gave be an IV with sodium something and took blood. I peed about ten more times whilst waiting for the results and did various other inappropriate things such as ask the doctor if he was really qualified and beg peanut M and M's from the physicians assistant!
The diagnosis was Hypokalemia or potassium deficiency so they gave me some disgusting potassium tablets. This is essentially very similar to Hyponatremia (insufficient sodium or too much water causing imbalance of sodium level.) and I suspect I had both. I have done some surfing to try to find more info on both. The Hyponatremia is pretty well associated with endurance activities and understood for marathon and ultra-marathon runners but the Hypokalemia does not seem to be so associated (the articles that I found were more around people using diuretics.) The runner's world articles that I found are now recommending using the thirst response instead of drinking ahead of thirst which was previously recommended, to me this is a difficult thought to get my head around having been taught that by the time you are thirsty it is "too late". I will try to find them again and link them here.
Anyway sorry for the details and long post but I fell like this may be helpful to someone in the future. It was pretty scary to go through - I was convinced I was going to die on the grassy knoll!  


sommemi's picture

Hypokalemia - thanks 4 the info!

Wow - I'm so glad that you are ok! Thank you so much for posting this information! I have never heard of this before and am pretty new to the marathon thing so I don't know very much about Hyponaetremia either. It's good to know this kind of information for the future... and especially for anyone who is doing this kind of stuff for the first time! No wonder we eat bananas along the way! (And here I just thought they kept handing them to me cause I looked like a monkey when I skated with my arms hanging down...)  :-)

If I read anything like this I'll post it here too. Thanks again... glad you are feeling better now!


eebee's picture

Great to Hear from you, KJG

Blimey! You really were out of it. Definitely no need to apologize for the long write-up. Not only is it good to hear YOUR story of how you were doing (very funny, too, now that you're out of the woods), but to help get more info out there for anybody else who might end up in such a predicament. Clicking and Whirring noises! Sounds like one of those Geonosian alien-things from Star Wars II.


Low potassium (Hypokalemia) put me in the ER last year, also, but not from hours & hours of non-stop skating: from about 3 days of not eating! They gave me some potassium tablets, which ironically, I just found again this a.m. The Hypokalemia also caused me some kind of cardiac arrhythmia, where my heart lurched into a palpitation, paused and just never got started again in time to prevent me passing out sitting at my desk at work. Thank God I wasn't driving.


Interesting what you said about waiting until you're thirsty before drinking water. When I'm drinking some really thick, salty sports drink I'm ok if I sip before getting parched. On the other hand, the really thick, salty sports drink usually causes me to crave ice cold water, so I guess it works out over the long haul.


So for extreme sporting events like A2A, more is better, as long as it's not water! More salt, potassium, calories...anything I'm forgetting?


I hope you continue to get well, KJG, and keep us posted.


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