Straight to the Vein: Intravenous Rehydration in Endurance Athletes

Article:    Is Postevent Intravenous Hydration an Appropriate Service at Endurance Competitions?    By: Hoffman et. al.4

Marathon  The Denver Post reported last July that more athletes are turning to using intravenous (IV) hydration after events in an attempt to recover quicker.1  OnusIV is one of multiple services that is offering IV hydration to athletes, and they even partnered with a local athletic club to offer discounts to its members.  Their basic IV is normal saline, but they offer Toradol, Zofran, Tylenol, Glutathione, calcium, magnesium, Zinc, and other vitamins (vitamin B, D and C) and amino acids as additives.  The prices range from $65 for the basic saline pack, to the $135 vitamin cocktail that was special concoction of John Meyers, the man who first developed and offered IV hydration mixtures to treat a variety of medical conditions over 30 years ago.  The co-founder of OnusIV was quoted saying “it’s still very much just theory at this point…but theory plays out again and again.”1

Football

The National Football League (NFL) previously reported 75% of their teams gave their players IV infusions to hyperhydrate before a game, but did not comment on its use during or after games. 2 The benefits of pre-exercise hydration have only been seen in exercise that is continuous (unlike football), high intensity, in hot and humid conditions and induces a loss of >2% body weight.2  The use of IV hydration has been banned by the World Anti-Doping Agency (WADA) since 2005, with the only exception being one “legitimately received in the course of hospital admissions, surgical procedures or clinical investigations.”3  The biggest concerns of WADA were the potential use of IV hydration to administer prohibited substances, or for athletes who cut extreme amounts of weight before competitions and want to quickly rehydrate.2  Another concerning finding by the NFL study was that almost half the responding players had a previous complication from the IV procedure.1

IV

So what about postevent IV hydration? A recent editorial sought to discuss this issue.4  The authors reported a past event where such a service was advertised at an ultramarathon, and when they inquired as to the screening of athletes for conditions such as exercised associated hyponatremia, where IV fluids may worsen the condition, the ads were rapidly removed.  In the past, dehydration was somewhat demonized and it was believed that over-hydration was the key to enhanced performance at endurance events.  However, the authors report that dehydration up to 4% loss of body weight does not significantly impair the athletes or lead to detrimental effects on their performance.  More severe levels of dehydration have still not been found to benefit from IV over oral hydration, and even in heat illness it was proven that oral and IV rehydration were equally beneficial as long as the patient was not altered and could keep oral rehydration down.5

Drinking water

The authors report the current guidelines are to give IV hydration only if two conditions are met: the athlete cannot tolerate oral fluids AND shows symptoms of hypovolemia (tachycardia, orthostatic hypotension, dry mucus membranes, poor skin turgor).4  They also point out that a careful assessment for hyponatremia needs to be undertaken every time IV fluids are considered as it is common in endurance athletes, often presents with non-specific symptoms, can worsen with isotonic or hypotonic fluid administration, and can be deadly if unrecognized.4  Lastly, putting in a IV comes with an inherent risk of complications such as infection, infiltration, air embolism, hematoma and potential intraartial injections (rare).

The bottom line of the article: IV hydration has a place, but requires careful medical screening (which does not appear to occur with commercial IV hydration services) and has not shown proven benefits in the average endurance athlete who doesn’t display medical need.

 

References

  1. Jannetta, J. (2015, July 14). Endurance athletes turn to hydration by IV despite medical skepticism. The Denver Post. Retrieved from http://www.denverpost.com/lifestyles/ci_28477931/endurance-athletes-turn-hydration-by-iv-despite-medical
  2. World Anti-Doping Agency. The World Anti-Doping Code International Standard, January 2016 Prohibited List. World Anti-Doping Agency Web site. https://wada-main-prod.s3.amazonaws.com/resources/files/wada-2016-prohibited-list-en.pdf
  3. Fitzsimmons S, Tucker A, Martins D. Seventy-five percent of National Football League teams use pregame hyperhydration with intravenous fluid. Clin J Sport Med. 2011;21:192–199.
  4. Hoffman, M. D., Hew-Butler, T., Roberts, W. O., Rogers, I. R., & Rosner, M. H. (2016). Is Postevent Intravenous Hydration an Appropriate Service at Endurance Competitions? Wilderness & Environmental Medicine, 27(1), 7-9. doi:10.1016/j.wem.2015.12.014
  5. Castellani JW, Maresh CM, Armstrong LE, et al. Intravenous vs. oral rehydration: effects on subsequent exercise-heat stress. J Appl Physiol. 1997;82(3):799-806.