Urine Reagent Strips for Assessing Hypohydration — Do They Work?

Hydrated or not?

Hydration status is an important issue in sports medicine.  Both ends of the spectrum — hypo and hyperhydration — increase risk for morbidity and mortality in the athlete.  As we all know, maintaining euvolemia is an important step in the prevention of heat illness, as the evaporative effect of sweating is one of the body’s mechanisms for heat dissipation.  Conversely, as my colleague and CJSM author Dr. Tamara Hew-Butler has argued on different platforms, a zeal to overhydrate can lead to hyperhydration, hyponatremia, and in extreme cases, death.

There is another way we concern ourselves with hydration status in sports medicine, and that is when assessing athletes who compete in weight classes, or when doing urine drug testing as a screen at a doping control station in competition.  Typically, such assessments are done using different testing modalities on urine specimens.

I am a Medical Delegate for the Federation Internationale de Natation (FINA) and am involved in doping control at long-distance swimming events.  Urine drug screens cannot reliably be done on dilute urine specimens.  In most settings we use refractometry but in some more remote or less developed venues, we may need to use urine reagent strips [WADA has different standards of specific gravity (SG) suitable for urine testing depending on whether refractometry or urine reagent strips are used].

More commonly, here in central Ohio, is the need to assess for hypohydration in the popular sport of wrestling [wrestlers — and other athletes competing in weight classes — will frequently sweat and minimize fluid intake prior to a competitive weigh-in to ‘make weight’ in the class in which they want to compete].  In Ohio high school wrestling, urine reagent strips only are used, and the standard is any sample with SG >1.025 results in a disqualification, with a minimum time period of 48 hours before reassessment.

Having an interest in all these dimensions of testing an athlete’s hydration status, I read with great interest the Brief Report that was published in the November 2019 CJSM: Urine Reagent Strips Are Inaccurate for Assessing Hypohydration: A Brief Report. Read more of this post

Open Water Swimming


Sunrise over Lac St. Jean, site of FINA 10K and 32K open water swimming events

Amazing to think that the Rio Olympics opening ceremony takes place a mere week from now.

I am, currently, enjoying the good fortune of mixing with Olympians from several countries who will be headed there for the open water swim events.  This weekend I am in Roberval, Canada (3 hours north of Quebec City), at Lac St. Jean — where the FINA/HOSA 10K marathon World Cup and 32K Gran Prix events are taking place.

I am a FINA medical delegate at these events.  I have written about this experience before in a 2013 blog post:  the 32K Gran Prix event coincides with an historic open water swim that has been done for decades on this lake, the Traversee internationale du lac St-Jean.

It is a great pleasure to be involved in an international sporting event like this one.  The local organizing committee does fabulous work.  I am privileged to work with fellow FINA representatives from New Zealand and France. Outside of the work hours, we get to socialize some and partake in the hospitality of the Roberval community.

I also greatly enjoy working for the athletes, watching out for their health and safety.  I genuinely enjoy getting to know them and experience vicariously the thrill of their competition. The joy and challenges of sport are a special dimension of human culture —  I am sure this is what leads many of us to sports medicine.

I think it is those broader, aspirational aspects of sport that lead many of us in the sport medicine community to push back on efforts toIMG_2210 cheat, such as doping.  And it’s no surprise that for an elite, international event like this one FINA has doping surveillance as part of its core mission.  One of the roles I play during my time on site is to supervise the excellent work done by representatives of the Canadian Centre for Ethics in Sport, which conducts post-race testing on select individuals many of whom, as I have indicated, will be swimming soon in Rio, where we already have had headline-making doping news before the games have even begun!

We have published frequently on the issue of doping in the pages of CJSM and these blog pages.  We hope you take this chance to click on those links and look at some of that work, in advance of the upcoming Olympics.  And, since it’s Friday, it’s time to follow something new — I would suggest the Facebook page of FINA, which is so well done, and will be hopping with information about this weekend’s Traversee and next month’s Olympics.

Enjoy the Games!  Let them be competitive, safe, and clean.

Major League Baseball: the All-Star game and more


CitiField, Home of the New York Mets
and host to the 2013 MLB All-Star Game

Major League Baseball’s (MLB) All-Star game takes place tonight at CitiField, the home field of the New York Mets.  The All-Star game has a rich history and in the culture of MLB has always represented, at the very least, the mid-season pause where the collective baseball community could reflect on the game:  where it has been, and where it is going.

zack greinke at 2009 MLB all star game

Zack Greinke, pitching in the 2009 MLB All-Star game
(He will not play in the 2013 edition)





From the perspective of sports medicine, this baseball season has been a rich one already.  From Zack Greinke’s clavicle fracture and surgical repair, to Derek Jeter’s recovery from ankle surgery and quad strain, to the, er, inimitable ARod’s hip surgery and the ever growing issue of PEDs in MLB,  it’s been a very interesting spring and early summer.

In the spirit then of this mid-season pause, I wanted to sit back and review just a few baseball-related, clinical sports medicine issues before we all enjoy the game tonight. Read more of this post

Boosting – time to be aware

Most Sports Physicians are well aware of the issue of doping in elite sport and many of the methods used by sports participants. However, some of us may well not have come across a method used by some athletes with a disability called ‘Boosting.’ With the forthcoming Paralympics just around the corner, now is the time to consider this method of doping for those of us who are involved with events later on this year in London 2012.

Some athletes with a high level spinal cord injury (T6 and above) may voluntarily induce an episode of autonomic dysreflexia (AD) prior to, or during, an event in order to enhance their performance. A variety of methods may be used by athletes, including clamping catheters, sitting on sharp objects, and using tight leg straps.

The resulting physiological response leads to a significantly raised blood pressure, with improved blood flow to working muscles. The performance enhancement that may ensue as a result of this response may be significant and lead to an improvement in VO2.

It is not always easy to determine whether or not a deliberate attempt to induce AD has taken place as AD is not uncommonly caused by a number of common triggers including urinary retention due to catheter blockage or misplacement, infections, constipation, or noxious stimuli from other sources such as pain due to a lower limb injury.

My first clinical encounter with a patient with AD was during my registrar training when I was working on a spinal cord injuries unit (SCIU) – the cause on that occasion was a blocked catheter. Recognition was swift due to the awareness of the ward nursing staff to the condition. The patient was treated with nifedipine plus a catheter replacement and bladder washout, and made a swift and uneventful recovery. I was to encounter a few more episodes of AD occurring in in-patients during the next 6 months when I was working on the SCIU.

Whilst not only banned by the International Paralympic Committee as a doping method, boosting is dangerous to the health of athletes and may lead to a hypertensive crisis, stroke and death.

The signs and symptoms of mild-to-moderate AD include piloerection, sweating above the level of the spinal cord lesion, headaches, blurred vision, bradycardia, facial flushing, nasal congestion and anxiety. Systolic blood pressure may rise to over 250mmHg.

Athletes are routinely checked prior to competition for any of these signs and symptoms, and repeated blood pressure measurements are taken if there is any suspicion of boosting or AD. If a systolic blood pressure of 180mm Hg or higher is persistently measured, then the athlete is not allowed to compete in the event and possible causes of AD are searched for.

In this month’s Thematic issue of the Clinical Journal of Sport Medicine on Paralympic Sports Medicine, our featured freely-available article by Krassioukov focuses on blood pressure control and AD in athletes, discussing the physiological mechanisms behind this doping method and what we know about the practice of boosting.

For those who may wish to raise awareness of boosting as a doping method, there is a useful presentation on AD and boosting available on the official website of the Paralympic movement, funded in part by the World Anti Doping Agency (WADA) and the IPC.

(Image of Iran v South Africa at 2008 Paralympic games available at Wikimedia Commons, and Autonomic Nervous System originally from ‘Gray’s Anatomy’ )

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