Two twin brothers, Frank and Joe, were biking along the historic Lewis and Clark trail. On the 20th day, Joe began experiencing dizziness, fatigue, and other symptoms of dehydration. He was admitted to the emergency room. Lab tests showed that Joe was severely dehydrated, with a urinalysis osmolality level far above normal. It was determined that Joe's excessive caffeine intake from coffee and energy drinks, combined with the hot weather and lack of adequate fluid replenishment over 20 days of cycling, had led to hypovolemic shock from dehydration.
Two twin brothers, Frank and Joe, were biking along the historic Lewis and Clark trail. On the 20th day, Joe began experiencing dizziness, fatigue, and other symptoms of dehydration. He was admitted to the emergency room. Lab tests showed that Joe was severely dehydrated, with a urinalysis osmolality level far above normal. It was determined that Joe's excessive caffeine intake from coffee and energy drinks, combined with the hot weather and lack of adequate fluid replenishment over 20 days of cycling, had led to hypovolemic shock from dehydration.
Two twin brothers, Frank and Joe, were biking along the historic Lewis and Clark trail. On the 20th day, Joe began experiencing dizziness, fatigue, and other symptoms of dehydration. He was admitted to the emergency room. Lab tests showed that Joe was severely dehydrated, with a urinalysis osmolality level far above normal. It was determined that Joe's excessive caffeine intake from coffee and energy drinks, combined with the hot weather and lack of adequate fluid replenishment over 20 days of cycling, had led to hypovolemic shock from dehydration.
Lewis and Clark Reloaded: The 3,041-Mile Bike Trail Case Study The story of two fraternal twins, Frank and Joe, They are both hat are trying to follow the historic trails of Lewis and Clark on a bike. They were both well prepaid for this event until Joe has a medical event and were admitted to the hospital. Also this case study covers both the legal and ethical ramification of excess intake of this ergogenic aid. Part IThe Adventure Begins and Comes to a Screaming Halt The body systems that are affected and what physiological are expected for an rigorous exercise following the strenuous task as this multi day event. Rigorous exercise primarily affects the skeletal system in the area of bone-mineral density. Providing weight-bearing loads on the body significantly affects the integrity, stability and strength of bone. Bone-mineral density is improved through chronic exercise in the form of resistance training. There are a variety of positive changes that occur in the cardiovascular system due to rigorous exercise participation. Rigorous exercise increases several vital components of the cardiovascular system such as heart size, stroke volume, cardiac output, blood flow and blood pressure. Additionally, rigorous exercise affects risks factors related to the cardiovascular system. The signs and symptoms that Joe shows on the 20 th day are dizziness, fatigue, headache, muscle ache, stomach ache. This indicates that is showing the classic signs and symptoms of dehydration. Also a secondary potential diagnosis is an infection. Part IIA Change of Scenery To this point the case study has focused on the event prior to the syncope episode. Now Joe has been admitted to the Emergency Room and we have some additional resources like lab values. Running head: Lewis and Clark Case Study 3
The new relevant information that we have obtained is relevant to the case because the lab results are important in determining the level of dehydration and potential infection. Evaluating the hematology labs levels you notice that all levels are elevated. Lets leave out the White blood cell count at this time and focus on the others. The elevated RBC, Hgb, Hct, Neturophiles indicates that he is an excellent physical shape and his body has increased this levels to improve the oxygen intake to the bodys increased needs over the past 20 days of biking. The WBC count is elevated because temporarily increased, due to intense exercise, in response to tissue damage but as the cells move from your blood to the injured tissue; your white blood cell count will decrease. Urinalysis is the most important test that we have available at this time, since it indicates that he is massively dehydrated. Osmolality level of 1700 mOsm/L, since what is considered normal 801300 mOsm/L., evaluating this level, he needs fluids because he is hypovolemic and showing signs and symptoms of shock. There are several questions to ask both Joe and Frank: How many glasses of water were they drinking a day? Was the water filter water or tap water? How long of rest were they taking? Food Intake? Supplement use. Additional labs to order are: Serum sodium, Potassium, Chloride, Glucose, BUN and Creatinine, with purpose to develop a treatment plan for more focused approach in selecting the correct rehydration formula. Part IIIA Dangerous Detour Running head: Lewis and Clark Case Study 4
Our patients diagnoses are hypovolemic shock secondary to dehydration due excessive caffeine intake from coffee and energy drinks. He has shown the classic signs and symptom with a syncope episode, dizziness, fatigue, headache, muscle ache, stomach ache. One important risk factor is the weather in the Midwest during this time of the year it is very hot during the summer months and often the temperature will reach 100F. Extensive caffeine intake will also increase the risk for dehydration, since it also have a diuretic effect. Also we have to remember that after 20 days of exercise they will both be chronic dehydrated. They will be hard for them to replenish all the fluids lost during this time with only oral fluids. Summary Questions Ergogenic aids are substances, devices, or practices that enhance an individuals energy use, production, or recovery (The Board of Trustees of the University of Illinois, 2011). Ergogenic aids cover everything from Gatorade to banned substance as anabolic steroids. One common ergogenic aid used by athletes is caffeine that is legal to use in athletic completion (to a certain urine level) Caffeine is well absorbed from by the stomach and intestine, and peak blood levels occur about 45 - 60 minutes after ingestion. Once in the blood stream, caffeine causes a number of responses in the body. Caffeine is well known for its stimulant effects on the brain, but there are a number of other physiologic effects that occur. Blood pressure, pulse rate, and stomach acid production are increased, fat stores are broken down, and fatty acids are released into the blood stream. These effects can last from a few hours to as long as 12, but within 4 days of regular use, the body develops tolerance to many of the effects of caffeine. Caffeine is being used according to Cox et al.,(2002) Running head: Lewis and Clark Case Study 5
a study conducted on cyclists found that consuming 6 mg caffeine per kg body weight (about 355 mg for a 130 lb person, or three to four cups of coffee) improved performance times during a cycling trial, regardless of whether caffeine was ingested one hour before exercise or in a series of doses throughout the trial
References The Board of Trustees of the University of Illinois. (2011).Ergogenic aids: Nutritional supplements for athletes. Retrieved from http://www.mckinley.illinois.edu/handouts/ergogenic_ aids.html
Cox, G.R., Desbrow, B., Montgomery, P.G., Anderson, M.E., Bruce, C.R., Macrides, T.A., Martin, D.T., Moquin, A., Roberts, A., Hawley, J.A., Burke, L.M. Effect of different protocols of caffeine intake on metabolism and endurance performance. J Appl Physiol. 2002; 93:990999.