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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current evidence indicates that adequate fluid ingestion during exercise enhances athletic performance, prevents a fall in plasma volume, stroke volume, cardiac output and skin blood flow, maintains serum sodium concentrations and serum osmolality, lowers rectal temperature and the perception of effort, and prevents a progressive rise in heart rate. Rates of sweating and urine flow are not influenced by fluid ingestion. The evidence suggests that the maintenance of serum osmolality and serum sodium concentrations at pre-exercise levels is the important determinant of these beneficial effects of fluid ingestion on cardiovascular function and thermoregulation. The provision of glucose in the ingested solution may be necessary to optimize performance; glucose ingestion that enhances fluid and sodium absorption in the small bowel may also present a progressive rise in oxygen consumption during exercise. Sweetened carbohydrate-containing drinks may also increase fluid intake during exercise, thereby minimizing voluntary dehydration. Hence, the optimum solution for ingestion during exercise should provide carbohydrate, probably at rates of about 1 g/min and electrolytes in concentrations that, when drunk at the optimum rate, maintain serum osmolality and plasma volume at pre-exercise levels by replacing exactly that water and electrolyte losses from the extracellular space. At present, the composition of the fluid that will optimize electrolyte and fluid replacement of the extracellular space is not established. Neither are the optimum rates of fluid ingestion during exercise known. At low sweat rates (< 1 liter/hr), it is probable that all of the lost fluid can and should be replaced; rates of fluid ingestion needed to offset higher sweat rates may exceed the maximum intestinal absorptive capacity for water. Furthermore, high rates of fluid intake (> 1 liter/hr) are achieved with difficulty during exercise, especially when running, and are likely to lead to feelings of abdominal discomfort, possibly due to the accumulation of unabsorbed fluid in the small bowel or colon. Practicing to drink regularly during training might reduce the severity and frequency of these symptoms, possibly by increasing intestinal absorptive capacity. Most athletes are "reluctant" drinkers during exercise and do not ingest fluid at rates equal to their rates of fluid loss; hence, they develop progressive (voluntary) dehydration during prolonged exercise. Surprisingly, the level of voluntary dehydration that develops during exercise is relatively independent of the duration or intensity of the activity. The factors that explain these phenomena remain elusive. Fluid consumption during exercise is enhanced by the ingestion of cold, sweet fluids. Simultaneous food consumption also stimulates fluid ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fluid replacement during exercise. 850 45

Xylazine (XYL) administration in horses is accompanied by significant cardiovascular depression characterized by a 25-35% decrease in cardiac output (CO) which is likely to compromise tissue oxygen delivery (DO2), and usually vagally mediated bradycardia is an important cause of this reduced cardiovascular performance. To examine the possible benefit of preventing the bradycardiac response, 6 healthy horses were treated with intravenous (IV) saline (SAL) or 2.5 micrograms/kg glycopyrrolate (GLY) in a blinded, randomized, crossover trial. Fifteen minutes later, 1 mg/kg XYL was administered IV and systolic, diastolic and mean blood pressures (SBP, DBP, and MBP, respectively), central venous pressure (CVP), mean pulmonary artery pressure, heart rate (HR), CO, and arterial and mixed venous blood gases were measured at the following times: baseline, 2, 5, and 10 min post-SAL or GLY; and 2, 5, 10, 15, 30, 45 and 60 min post-XYL. Determination of cardiac index (CI), stroke index (SI), left ventricular work, systemic vascular resistance (SVR), DO2, oxygen uptake, and oxygen extraction ratio were made at the same time. Gastrointestinal (GI) motility was evaluated by four-quadrant auscultation for 24 h post-XYL. Statistical analysis of continuous variables was carried out using ANOVA for repeated measures and Wilcoxon's rank-sum test for non-parametric data. In GLY treated horses, HR, SBP, MBP, DBP, CI, DO2 and mixed venous oxygen tension were significantly higher up to 30 min after XYL (P < or = 0.02) while CVP and SI were significantly lower 2 and 5 min post-XYL, respectively. In both groups, GI motility as assessed by auscultation was virtually abolished for an hour, with a non-significant tendency for the decrease in motility to last longer in the GLY/XYL group. None of the treated horses developed abdominal discomfort. No significant difference was observed in the other variables. The study shows that 2.5 micrograms/kg GLY premedication reduces the cardiovascular depression caused by 1 mg/kg XYL, without adversely affecting GI motility.
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PMID:Modification of cardiopulmonary and intestinal motility effects of xylazine with glycopyrrolate in horses. 911 60

A 27-year old female had one episode of transient loss of consciousness and several of near-unconsciousness during strenuous exercise and sexual activity. Episodes started with abdominal discomfort or nausea and light headedness. Unconsciousness never exceeded one minute. When trying to stand up, she felt she would lose consciousness again. We performed a bicycle ergometer exercise test, continuously monitoring blood pressure via non-invasive finger photoplethysmography (Finometer, FMS, The Netherlands). Beat-to-beat changes in stroke volume, cardiac output and total peripheral resistance were calculated using Modelflow (FMS, The Netherlands). At a power of 140 W, the patient reported being near exhaustion; shortly after this she reported nausea. She stopped cycling 30 s later, then saw "black spots" and felt an oncoming loss of consciousness. Dismounting the ergometer and squatting provided immediate relief from symptoms. Symptoms during the test were similar to those during previous episodes. The diagnosis was exercise-induced vasovagal reactions. This is the first report that documents the beat-to-beat changes in blood pressure, stroke volume and total peripheral resistance during exercise-induced vasovagal syncope. It illustrates the usefulness of combining exercise testing with continuous non-invasive blood pressure monitoring in the diagnostic work-up of exercise-induced syncope, and shows the therapeutic value of squatting to prevent loss of consciousness in exercise-related vasovagal syncope.
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PMID:Syncope during exercise, documented with continuous blood pressure monitoring during ergometer testing. 1576 6

Lactic acidosis is a known adverse risk of metformin treatment. We report two cases in whom fulminant lactic acidosis developed during treatment. There were no contraindications to metformin treatment and both were admitted with abdominal discomfort for some days, causing dehydration. Both patients had renal failure on admission, developed multiple organ failure and both suffered a massive stroke. One patient died and the other survived but is severely disabled. We suggest, in both cases, that acute renal failure developed as a result of dehydration, causing metformin accumulation and lactic acidosis. We recommend that all patients on metformin should consider discontinuation of metformin treatment in the event of a severe medical condition causing dehydration.
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PMID:Fulminant lactic acidosis in two patients with Type 2 diabetes treated with metformin. 1617 12

Patients with acute coronary syndromes (ACS) who are accompanied by atypical symptoms are frequently misdiagnosed and under-treated. This study was conducted to examine and compare the factors associated with atypical symptoms other than chest pain in younger (<70 yr) and older (> or =70 yr) patients with first-time ACS. Data were obtained from the electronic medical records of the patients (n=931) who were newly diagnosed as ACS and hospitalized from 2005 to 2006. The 7.8% (n=49) of the younger patients and 13.4% (n=41) of the older patients were found to have atypical symptoms. Older patients were more likely to complain of indigestion or abdominal discomfort (P=0.019), nausea and/or vomiting (P=0.040), and dyspnea (P<0.001), and less likely to have chest pain (P=0.007) and pains in the arm and shoulder (P=0.018). A logistic regression analysis showed that after adjustment made for the gender and ACS type, diabetes and hyperlipidemia significantly predicted atypical symptoms in the younger patients. In the older patients, the co-morbid conditions such as stroke or chronic obstructive pulmonary disease were positive predictors. Health care providers need to have an increased awareness of possible presence of ACS in younger persons with diabetes and older persons with chronic concomitant diseases when evaluating patients with no chest pain.
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PMID:Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes. 1979 72

Fibromuscular dysplasia is a heterogeneous group of systemic, noninflammatory, and nonatherosclerotic diseases of the vascular wall. It is the second-most common abnormality of the renal artery. Although hypertension is the most common presenting symptom, other symptoms, such as pulsatile tinnitus, stroke, chest pain, or abdominal discomfort, may result from other affected vascular beds. Revascularization of the renal artery appears to be effective at lowering blood pressure in many patients with renal artery fibromuscular dysplasia. For a long time, the intrarenal pathophysiological changes and mechanisms leading to hypertension had hardly been studied in patients with renal artery fibromuscular dysplasia. Recent data, however, has provided more insight into the effects of renal artery fibromuscular dysplasia on the intrarenal microvasculature and the intra-renal renin-angiotensin system in these patients. Moreover, these data have changed our view of the pathophysiological mechanisms leading to hypertension in patients with renal artery fibromuscular dysplasia. In this review, we will discuss recent clinical and scientific developments regarding renal artery fibromuscular dysplasia with an emphasis on its effects on the kidney.
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PMID:Renal artery fibromuscular dysplasia and its effect on the kidney. 2996 47