Medical Question - vomiting, dizzines - dehydration?

Triathlon Forum
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I was a couple hours into a tough bike ride when I started feeling sick. Basically my stomach no longer wanted anything in it. I could feel a weird sensation in my throat/neck whenever I swallowed anything, whether a swig of water or just saliva. It quickly got worse and worse till everything from breakfast came back up. Then in about 20 minutes the same exact thing happened again. My stomach started pushing everything up till eventually I had to heave it out. This happened four times before I was able to get home. Other symptoms were dizziness and tingling sensation in the hands, mostly occurring during the vomit attacks.

It was a little hot. I think it hit 90F, sun shining bright, black asphalt road, little wind, and I was pushing myself a little doing some hill training. I am in good shape though, been cycling and running consistently for a few years now. I was drinking lots of fluids too.

This has happened in the past. Once when I was much younger and went hiking with beer instead of water. Another time, during a tough 10K run, all uphill, in the heat. It happened to me on a few occassions when working in constuction in 120 degree attics. I’ve always chalked it up to dehydration but I really don’t think that’s what it is.

Anyway, does anybody know what is going on when this happens? Why does my body suddenly want to expel everything in the stomach. And then won’t let anything back in for a few hours. Is it dehydration of some sort? Lack of salt? Body overheating? What can I do to avoid this from happening in the future?

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Wow, I wish I had more time for a better reply (we’re really busy right now- sorry) but it sounds like dehydration and the beginning of a heat injury.

Be careful. This is very serious and goes from bad to much worse quickly.

If you have had one heat injury you tend to me more susceptible to them in the future, at least that what I was told in the military.

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If you have more time later, I would love to hear your thoughts on it. What exactly do you mean by “heat injury”? Haven’t heard that term before.

4

Wow, just weighed myself. I lost 4.5 lbs since this morning when I first woke up.

5

I’ll do some research and get back on this thread in the next 24 hrs.

6

Heat illness is a spectrum (from bad to worse) of symptoms that an individual can experience due to overheating. While proper hydration is certainly important in helping the body maintain it’s proper cooling mechanisms you can still become dangerously overheated (hyperthermic) even when properly hydrated. Typically, the first symptoms someone will notice (other than feeling really hot) are those of discomfort: cramps, nausea, dizzyness,headache. Unless the individual makes an effort to remove him/herself from the heat stress or begins actively cooling these symptoms will progress to difficulty concentrating, vomiting, severe cramps and even confusion. Further failure to heed these warnings will lead to seizuress and death (heat stroke).

Everyone responds to heat stress differently and even though individuals can certainly adapt to heat over time some are less well equipped than others to handle it. Bottom line, if it’s a warm day and you notice some of these symptoms and they seem to be progressing, its time to find some shade and kick your feet up.

EBMD

7

Heat illness is a spectrum (from bad to worse) of symptoms that an individual can experience due to overheating. While proper hydration is certainly important in helping the body maintain it’s proper cooling mechanisms you can still become dangerously overheated (hyperthermic) even when properly hydrated. Typically, the first symptoms someone will notice (other than feeling really hot) are those of discomfort: cramps, nausea, dizzyness,headache. Unless the individual makes an effort to remove him/herself from the heat stress or begins actively cooling these symptoms will progress to difficulty concentrating, vomiting, severe cramps and even confusion. Further failure to heed these warnings will lead to seizuress and death (heat stroke).

Everyone responds to heat stress differently and even though individuals can certainly adapt to heat over time some are less well equipped than others to handle it. Bottom line, if it’s a warm day and you notice some of these symptoms and they seem to be progressing, its time to find some shade and kick your feet up.

EBMD

I guess it’s safe to say the heat was one of the culprits but I don’t think it was the only one. I rode 105 miles in Death Valley last year where the temp hit 110. I can specifically remember really pushing the pace up Jubilee Pass at around high noon. There were people dropping left and right because of the heat. I remember “heating up”, feeling really hot, but had no ill effects from it. Of course Jubilee Pass wasn’t as long or as steep as I was doing today.

I didn’t hydrate in the days prior to todays ride as I normally would when I know a hard ride is coming up. Trying to make up for this I drank more liquids today than I normally would. Plus I had a few bites of hash brown, left over from breakfast, right before starting the ride. Also, I was wearing an all black jersey. So maybe it was a combination of a little overheating, plus too many liquids, the undigested hash brown, and the black jersey.

I just don’t understand why it came on so severe. After the first vomit it was atleast 3 hours before I was able to drink water and hold it down.

What about mixing fluids? Cytomax, Gatorade, and water - would this cause stomach problems?

What about dumping water on head? I was doing alot of that. Does this effect the bodies natural cooling abilities?

Sheesh, I just don’t know.

8

I can’t pretend to know exactly “what went wrong” during your ride. Most likely it was a combination of dietary and environmental stress that your body just wasn’t willing to roll with that day. One thing about the old digestive system though, once it’s past the tipping point (vomiting or diarrhea) it aint gonna just quietly settle down in a few short minutes. It is usually a matter of hours (best case) or days until the underlying imbalances of fluid and nutrition absorption get back into balance. So the stomach’s defensive response is to reject any further intake until things are better able to handle it. This doesn’t mean you should stop trying to take in liquids when vomiting but you will probably only be successful with small amounts. Any continued stress ie hammering up the pass one more time will only make things worse.

As far as dumping water on your head,it will help but given the situation you describe…hot day, hammering hard the net effect on heat loss will be minimal. The biggest bang for the buck is to first stop producing heat…no more pedaling. Evaporation is actually more efficient than immersion in cold water in terms of helping to dissipate heat so turning around and coasting downhill (feel that cool breeze in your hair) would be another good move and don’t hesitate to look for shade.

The main purpose of my post was to highlight some of the nuts and bolts of heat illness which I do think had some role in your sufferfest. I can’t conquer the larger issue of GI distress in endurance athletics, it is a multifactorial dilema and many wiser than I have addressed it in this forum. Hope this was helpful.

EBMD

9

You very likely had hyponatremia or hyponatremia plus hyperthermia. Most of what has been ascribed to overheating of late is probably due to hyponatremia. There was a very good article on this subject in Physician and Sports Medicine 2-3 years ago. At one major marathon, if I recall, when they tested the body temperatures and Sodium levels in the runners who were diagnosed as hyperthermic, by the medical staff, the vast majority were hyponatremic. Very few were hyperthermic.

If I recall, Cytomax has relatively less Sodium than some other drinks. Water has none. On those long hot rides, enough sodium is very important. Low sodium levels cause dizziness, altered consciousness and even seizures.

On the subject of cooling. Water poured over your jersey can cool you down,if you are hyperthermic, especially on a bike where the apparent wind is high. The lower the humidity the better it works. However, the heat you generate could be greater than the heat loss. Once you are overheated, especially if you are fluid depleted, you may not circulate enough blood to your skin to help very much.

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What about dumping water on head? I was doing alot of that. Does this effect the bodies natural cooling abilities?

TCR2,

On very hot rides I will drink one bottle of water from the cooler of the convenience store and use the other to cool myself by pouring it over my head and the back of my neck.

I have been on two different rides, where the heat index exceeded 105 degrees and the one time it reached 110 degrees. I felt like I was cycling in front of an open oven set at 450 degrees!

On both those occasions I also purchased a bag of ice in addition to the water at the convenience store and placed the bag of ice on the back of my neck to help cool me down. The cold water on the head and the ice most certainly helped. But that is not to say that would be enough in all situations. Heat stress can be very serious stuff. If you are more susceptible to heat stress, you must work harder to prevent yourself from suffering its effects. You definitely need to study up on the topic and become more knowledgeable!

Good luck.

11

I would tend to agree with the hyponatremia myself. I went on a 40 mile bike followed by a 10 mile run yesterday, and was about 1lb down after the bike. After the run I was down 4-5lb and felt horrible. I took a Thermotab, drank 5 glasses of water, and 30 minutes later I was fine.
For me, the salt/water balance is pretty important. Several different things happen as far as I can tell:

  1. Low water, sufficient salt: lethargy, “puffy-feeling” hands. Some say that their feet feel “puffy” also but I’ve never experienced that.
  2. Low salt, sufficient water: cramps and aches.
  3. High salt, sufficient water: “puffiness” as in #1
  4. Low salt, low water: walking very slowly home. Usually my heartrate is low and stays low, where in all the other cases my heartrate is elevated but not unreasonable.
    I’ve found that a salt tablet (ThermoTabs or e-Caps Endurolytes) allows me to absorb a sloshing-full stomach of water in less than 10 minutes. Nausea was always a problem with Gatorade and dehydration, as your body attempts to suck all the water out of your stomach but is unable to because of the high sugar content. I stopped using Gatorade permanently because of this problem. I drink water, eat Gu gels, and have been experimenting with Endurolytes pills. My guess is that your nausea was due to having a lot of food/sugar in your stomach and having a severe lack of water to allow the pH to be sane or to allow digestion. In my experience once you hit a certain point there is no saving it, but at the first sign of nausea drinking a lot of water immediately might help. If you are in dilutional hyponatremia then that would be a bad idea though, as it just makes the low-salt condition worse.