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Bob Murray, John Stofan and Bob Sallis


This article summarizes a case of ischemic colitis suffered by a triathlete during an Ironman competition.


Exercise results in a significant reduction in splanchnic blood flow to help maintain cardiovascular function. When dehydration and heat stress accompany exercise, blood flow to the splanchnic vasculature is further reduced, increasing the risk of local ischemia and tissue injury.

Differential Diagnosis:

Ischemic colitis caused by dehydration and heat stress.


Right hemicolectomy involving a 16-cm segment of ischemic large intestine and appendectomy the day following the race.


This case study highlights one of the risks associated with dehydration during prolonged exercise in the heat. Of particular interest are practical interventions to reduce health and performance issues.


Poor hydration and nutrition practices during intense exercise can affect gut function, impair performance, and jeopardize health. Optimal intake of fluid, carbohydrate, and salt will enhance performance and reduce risk to health.

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Damir Zubac, Drazen Cular and Uros Marusic

official weigh-in) to discourage aggressive weight-reduction despite the tragic events in combat sports, including death. 3 , 4 Recently, Reljic et al 5 proposed that adverse health-related issues in adolescent boxers originate from body-fluid manipulations, primarily achieved by acute dehydration, to

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Giannis Arnaoutis, Panagiotis Verginadis, Adam D. Seal, Ioannis Vogiatzis, Labros S. Sidossis and Stavros A. Kavouras

Maintaining fluid homeostasis is vital for optimal athletic performance in both youth and adults. The loss of plasma volume (hypovolemia) concomitant with dehydration results in cardiovascular and thermoregulatory strain due to elevation of heart rate and decrease in cardiac output, ultimately

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Julian A. Owen, Matthew B. Fortes, Saeed Ur Rahman, Mahdi Jibani, Neil P. Walsh and Samuel J. Oliver

No consensus currently exists on the best method to assess dehydration and prescribe fluid intake ( Armstrong, 2007 ; Cheuvront & Kenefick, 2014 ; Cotter, Thornton, Lee, & Laursen, 2014 ). This is in part because dehydration is a complex condition that manifests as different types. When fluid

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Paola Rodriguez-Giustiniani and Stuart D.R. Galloway

as drink composition and volume ( Shirreffs & Maughan, 2000 ), but it is also believed that hormonal changes associated with the menstrual cycle can influence fluid retention ( Fortney, 1996 ). Although fluid replacement after dehydration has been extensively studied in males, there have been few

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Jason D. Vescovi and Greig Watson

accepted thresholds for dehydration and hypohydration, respectively. However, applying group-level data without knowing individual variation might not represent best practice. To date, only one study has examined the intraindividual variability of body mass and reported three consecutive days of morning

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Devin G. McCarthy, Kate A. Wickham, Tyler F. Vermeulen, Danielle L. Nyman, Shane Ferth, Jamie M. Pereira, Dennis J. Larson, Jamie F. Burr and Lawrence L. Spriet

∼70-minute practices. Thus, ice hockey goaltenders produce high sweat rates, reflecting a large physiological demand, and can lose >2% BM during practices. Becoming mildly dehydrated (1%–3% BM loss) during exercise increased heart rate (HR), core temperature ( T c ), and perceived fatigue. 6 – 9

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Liam Sayer, Nidia Rodriguez-Sanchez, Paola Rodriguez-Giustiniani, Christopher Irwin, Danielle McCartney, Gregory R. Cox, Stuart D.R. Galloway and Ben Desbrow

Individuals typically do not consume enough fluid during exercise to counteract sweat losses, producing a postexercise state of body water deficit (i.e., dehydration; Garth & Burke, 2013 ). As a result, individuals are encouraged to drink fluid during recovery to reinstate total body water balance

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Yasuki Sekiguchi, Erica M. Filep, Courteney L. Benjamin, Douglas J. Casa and Lindsay J. DiStefano

exacerbated in a dehydrated state. 10 Thus, euhydration (optimal hydration) and dehydration trials during heat acclimation induction have been conducted to determine if there are additional benefits to dehydrated exercise trials on plasma volume, heart rate, internal body temperature, skin temperature, and

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Lawrence E. Armstrong, Jorge A. Herrera Soto, Frank T. Hacker Jr., Douglas J. Casa, Stavros A. Kavouras and Carl M. Maresh

This investigation evaluated the validity and sensitivity of urine color (Ucol), specific gravity (Usg), and osmolality (Uosm) as indices of hydration status, by comparing them to changes in body water. Nine highly trained males underwent a 42-hr protocol involving dehydration to 3.7% of body mass (Day 1, −2.64 kg), cycling to exhaustion (Day 2, −5.2% of body mass, −3.68 kg), and oral rehydration for 21 hr. The ranges of mean (across time) blood and urine values were Ucol, 1-7; Usg, 1.004-1.029; U08m, 117-1,081 mOsm • kg−1; and plasma osmolality (Posm), 280-298 mOsm ⋅ kg−1. Urine color tracked changes in body water as effectively as (or better than) Uosm, Usg, urine volume, Posm, plasma sodium, and plasma total protein. We concluded that (a) Ucol, Uosm, and Usg are valid indices of hydration status, and (b) marked dehydration, exercise, and rehydration had little effect on the validity and sensitivity of these indices.