Influence of Electrolytes Supplementation on Cardiac and Renal Functions after Prolonged Exercise in Male Rats

Transcription

1 World Applied Sienes Journl 23 (10): , 2013 ISSN IDOSI Pulitions, 2013 DOI: /idosi.wsj Influene of Eletrolytes Supplementtion on Crdi nd Renl Funtions fter Prolonged Exerise in Mle Rts 1 2 Hl F. Osmn nd Azz M. Aty 1 Rdioisotopes Deprtment, Nuler Reserh Center, Atomi Energy Authority, Egypt 2 Bsi Sienes Deprtment, Fulty of Physil Therpy, Ciro University, Giz, Egypt Sumitted: Jun 13, 2013; Aepted: Jul 20, 2013; Pulished: Jul 28, 2013 Astrt: Hevy sweting fter prolonged exerise n use ody fluid losses nd ltertion of the ody funtion. The purpose of this study ws to identify whether eletrolytes supplementtion promoting rehydrtion following exerise indued dehydrtion in mle rts. Animls ssigned into four equl groups. GroupI served s ontrol, GroupII nimls prtied exerise through trining progrm on tredmill,groupiii nimls exerised on tredmill then supplemented y Rehydrn-n ontent dissolved in wter. GroupIV nimls exerised on tredmill nd then supplemented y Rehydrn-n ontent nd (Mgnesium + Clium) itrte dissolved in wter. After 6 weeks nimls were slughtered nd the hrvested serum ws used to estimte retine phosphokinse (CPK), ltte dehydrogense (LDH) enzymes, kidney funtion (ure nd retinine), N, K, Cl, Mg, C, P ions nd ldosterone. Also hert nd kidney tissues were disseted out for histopthologil exmintion. The results reveled n inrese in CPK, LDH, ure nd retinine whih my e due to oxidtive stress.rehydrn-n or Rehydrn-n nd (Mgnesium +Clium) itrte tretment meliortes these effets nd these vlues deresed in groups III nd IV. N, Cl nd Mg deresed While K, C nd P inresed signifintly in exerised group, eletrolyte disorders hppen. In group III fluid lne hppen nd N nd Cl restored while K still inresed. Mgnesium nd lium ions inresed signifintly in group IV only. Group II showed rdi nd renl tissue dmge. Aldosterone level deresed in group II while it inresed in group III nd IV. In onlusion the restortion of ody fluid losses is neessry for optiml rdi nd renl funtions during exerise. Assuming tht rehydrtion strtegy fter exerise is neessry. Key words: Exerise Eletrolytes Crdi enzymes Kidney funtion Aldosterone INTRODUCTION requirements will depend on work rte, the mient limti onditions nd lso on individul physiologil During prolonged exerise in neutrl or slightly nd iohemil hrteristis of the thlete /worker [2]. wrm environments the mintenne of high swet All the physiologil perturtions tht n use erly rtes my led to progressive dehydrtion whih ftigue during exerise, dehydrtion is rguly the most will e ompnied y impired performne. Mild importnt, if only euse the onsequenes re dehydrtion will impir exerise pity nd prevent potentilly life thretening [3]. the thletes/workers from mking the est use of their There is lrge mount of evidene showing tht skills. In loomotor sports, suh s running or exerise indued dehydrtion hs negtive impt on yling, it hs een demonstrted tht retimes t mjor exerise performne nd restortion of fluid lne must hmpionship events re generlly poor when mient e hieved fter exerise. It is eqully well known tht temperture nd humidity re high nd sweting is musle glyogen must e restored fter exerise so tht perfuse eting [1]. the susequent performne not to e negtively ffeted Severe dehydrtion is potentilly ftl: exerise in the [4]. Athletes need more nutrients thn less tive people. dehydrted stte leds to rpid elevtion in ore They demnd more from their odies thn even verge temperture, hert rte nd the onset of het illness. An fitness uff nd so must ompenste with the right dequte fluid intke efore, during nd fter exerise n nutrients from foods or supplements to keep performne help to void the negtive effets of dehydrtion. Fluid nd reovery t its pek [5]. Corresponding Author: HlFwzy Osmn, Rdioisotopes Deprtment, Nuler Reserh Center, Atomi Energy Authority, Egypt. 1377

2 The more intense the exerise or sport, the greter the weight)for 45dys.Rte intke of drinks ws estimted y ody's nutrient needs. Athletes who prtiipte in onversion of humn dose to niml dose [11] nd on the endurne sports tht involve more thn one hour of se of the rt wter onsumption s follows: onsistent tivity hve speifi needs euse of wht they demnd from their odies. For exmples, thletes lose Animls dose/200g. B.W. = Humn dose 18/1000 more eletrolytes, suh s mgnesium, potssium nd sodium, through perspirtion nd must diligently reple Exerised Protool: The rts ustomed to the tredmill them [6]. exerise for 3dys efore tul experiment.the nimls in Sports drinks re idelly pled to fill oth these the prolonged exerise groups were exerised t rte 25 roles. It is ler tht drinking during exerise improves m/min for 5 min x 4 with puse of 2 min.the trining performne, provided tht the exerise is of suffiient progrm ontinue for 6 weeks in the Fulty of physil durtion for the drink to e emptied from the stomh nd therpy, Ciro University, Giz, Egypt [12]. e sored in the intestine [7]. All physiologi systems in the humn ody re Experimentl Design: Animls were rndomly divided influened y dehydrtion [8]. Swet eletrolyte losses into four equl groups. GroupI nimls served s ontrol depend on the totl swet losses nd swet eletrolyte group (non-exerised). Group II nimls exposed to onentrtions. Swet sodium onentrtion vries prolonged exerises. Group III nimls exposed to depending upon geneti predisposition, diet, sweting prolonged exerises then supplemented yrehydrn-n rte,het limtiztion stte nd swet onentrtions of ontent (Gluose nhydrous 4gm, tri-sodium itrte potssium, lium, mgnesium nd hloride verges. nhydrous 0.51gm, sodium hloride 0.7gm nd potssium Neither sex, mturtion, nor ging pper to hve mrked hloride 0.3gm) dissolved in 2 liter wter. GroupIV nimls effets on swet eletrolyte onentrtions; lthough exposed to prolonged exerises nd then supplemented dehydrtion n inrese the swet onentrtion of yrehydrn-n ontent plus (54mg/Kg Mgnesium itrte sodium nd hloride. Swet glnds resor sodium nd nd Clium itrte 66.5mg/kg of rt ody weight) hloride, ut the ility to resor these eletrolytes dissolved in 2 liter wter for 6weeks. At the end of dose not inrese proportionlly with the sweting rte experiment lood smples were withdrwn y rdi [9]. Of importne for rehydrtion purposes fter exerise punture fter nesthetiztion of rts using diethyl ether is onsumption of oth n dequte volume (greter thn lood ws olleted in len dry test tues nd the swet volume lose) nd quntity of sodium. Without entrifuged t 3000rpm for 10minutes nd ser were then oth of these, rehydrtion will e neither rpid nor seprted nd kept frozen for susequent iohemil omplete. There is, whoever, no good evidene for the nlyses. inlusion of ny other eletrolytes [10]. The im of this work ws to investigte the influene Biohemil Anlysis: Serum retin phosphokinse of eletrolytes supplementtion on rdi nd renl (CPK) nd ltte dehydrogense enzyme (LDH) were funtions fter prolonged exerise in mle rts. determined ording to method of Young [13]. Serum ure nd retinine were determined using spetro MATERIALS AND METHODS photometri nlysis [14,15]. Also Sodium nd Potssium ws estimted [16,17]. Chloride nd Animls: Forty mle lino rts weighting g were Mgnesium levels were evluted in serum y otined from the Ntionl Reserh Center, Egypt. The olorimetri method [18,19]. Totl lium onentrtion rts were limtized on stok diet nd tp wter tht ws ssyed in serum using olorimetri method [20]. were llowed d liitum. Inorgni phosphorous onentrtion ws determined using spetrophotometri method [21]. Aldosterone Chemil Tretment: Rehydrn-n (Gluose nhydrous hormone level ws evluted y the solid phse 4gm, tri-sodium itrte nhydrous 0.51gm, sodium hloride 125 rdioimmunossy (RIA) using I [22]. 0.7gm nd potssium hloride 0.3gm) ws otined from Sedio Phrmeutil Compny, 6 Otoer City-Egypt. Sttistil Anlysis: All dt were sttistilly nlyzed Also (Mgnisium itrte nd Clium itrte) otined s one-wy nlysis of vrine using the generl Liner from Ti Phrmeutil Compny, Egypt. All ontents Model, SAS softwre [23]. Dunn, multiple rnge tests dissolved in 2 liter wter nd djusted for dily ws used to seprte the mens when signifint supplementtion dose of Rehydrn-n ontent nd differenes exist. Sttistil signifine ws set t 0.05% (54mg/Kg Mgnesium nd Clium 66.5mg/kg of rt ody proility. 1378

3 Histologil Study: Hert nd kidney speimens of Tle (2) demonstrtes tht there ws signifint different groups were disseted out nd imedded inrese (P 0.05) in ure nd retinine levels of immeditely in 15% formlin for histopthologil exerised nimls ompring to ontrol. Rehydrn-n exmintion. The tissue smples were fixed, stined nd supplementtion in exerised group derese the levels investigted y light mirosope [24]. elow the ontrol vlue, lso in exerised group supplemented y Rehydrn-n+ (Mg+C )itrte there RESULTS is meliortion to the effet of dehydrtion nd the rtios eome (6.9 nd -5.9) ompred to ontrol. The results of hert enzymes in (Tle 1) reveled Also tle (2) shows tht sodium ions deresed tht in exerised group(i) CPK nd LDH enzymes signifintly (P 0.05) fter exerised while fter inresed signifintly (P 0.05) y 29.3 nd 24.6% supplementtion y Rehydrn-n nd Rehydrn-n+ ompred to ontrol group respetively. Rehydrn-n (Mg+C) itrte in group III nd IV the level of tretment in group III deresed these levels nd sodium ion restored ner to the ontrol vlue. While perentge eome(4.3%) for CPK while LDH still potssium ions level inresed signifintly (P 0.05) in inresed signifintly (P 0.05) y 27.6% ompred to exerised group. ontrol. In Exerised group supplemented yrehydrn-n The supplementtion y Rehydrn-n nd Rehydrnontent +(Mg nd C)itrte CPK nd LDH levels eome n+ (Mg+C) itrte in group III nd IV not ffeted on the ner to level of ontrol. level of potssium nd not return the vlue ner to ontrol Figure (1) mirosopi setions of hert from vlue. exerised group(1) showed leuoyti ells infiltrtion in Kidney setions of rt from ontrol group (2) rdi myoytes. Wheres other setions from reveled no histopthologil hnges. While in Rehydrn-n tretment group(1) reveled few fol prolonged exerising group (2) showing hylinosis of intermusulr inflmmtory ells infiltrtion. While glomerulr tufts. Moreover in Rehydrn-n group (2) Rehydrn-n+ (Mg+C)itrte tretment group (1d) vuoltions of epithelil lining renl tuules. Rehydrnshowing no histopthologil hngeslike those in n+ (Mg+C) itrte tretment group (2d) ongestion of ontrol group(1). renl lood vessel ws oserved. Tle 1: Effet of eletrolyte supplementtion on CPK nd LDH in different niml groups Groups Prmeters (I)Control (II)Exerised (III)Exerised+Rehydrn-n (IV)Exerised+Rehydrn-n+ Mg+C CPK (U/ml) 931± ± ± ±23.6 % Chnge LDH(U/ml) 457± ± ± ±17.9 % Chnge Dt re represented s men± S.E. Mens in the sme row with different supersripts re signifintly different (P 0.05). Tle 2: Effet of eletrolyte supplementtion on kidney funtion (serum ure, retinine)sodiumnd potssium ions in different niml groups Groups Prmeters (I)Control (II)Exerised (III)Exerised+ Rehydrn-n (IV)Exerised+ Rehydrn-n+ Mg+C Ure (mg/dl) 32.0± ± ± ±0.67 % Chnge Cretinine(mg/dl) 0.51± ± ± ±0.008 % Chnge N (mmol/l) 140.9± ± ± ±0.7 % Chnge K (mmol/l) 10.6± ± ± ±0.12 % Chnge Dt re represented s men± S.E.Mens in the sme row with different supersripts re signifintly different (P 0.05). Perentge of hnge ws lulted in omprison with ontrol. 1379

4 Fig. 1: Setions of hert:()hert tissues of rt from ontrol group showing no histopthologil hnges.()hert tissues of rt from prolonged exerised group showing few leuoyti ells infiltrtion in rdi myoytes. () Hert tissues of rt from prolonged exerised+ rehydrn group showing few fol intermusulr inflmmtory ells infiltrtion. (d) Hert tissues of rt from prolonged exerised+ rehydrn+(mg+c)itrte group showing no histopthologil hnges (H nd E; X=400). Fig. 2: Setions of kidney rts() Kidney of rt from ontrol group showing no histopthologil hnges. ()Kidney of rt from exerised+ rehydrn+ Mg ette+cl group showing hylinosis of glomerulr tufts. ()Kidney of rt from exerised+ rehydrn group showing vultions of epithelil lining renl tuules(d)kidney of rt from exerised group showing ongestion of renl lood vessel.(h nd E; X=400). 1380

5 Tle 3: Effet of eletrolyte supplementtion on serum hloride, mgnesium, lium nd phosphorous in different niml groups Groups Prmeters (I)Control (II)Exerised (III)Exerised+ Rehydrn-n (IV)Exerised+ Rehydrn-n+ Mg+C - Cl (mmol/l) 125.9± ± ± ±1.2 % Chnge Mg (mmol/l) 5.91± ± ± ±0.27 % Chnge C (mg/dl) 4.75± ± ± ±0.2 % Chnge P(mg/dl) 10.6± ± ± ±0.51 % Chnge Dt re represented s men± S.E. Mens in the sme row with different supersripts re signifintly different (P 0.05). Perentge of hnge ws lulted in omprison with ontrol. Fig. 3: Effet of eletrolyte supplementtion on ldosterone hormone level in different niml groups. Dt in tle (3) showed signifint derese n+ (Mg+C) itrte inresed the level of ldosterone in (P 0.05) in hloride ions in group II exposed to oth groups y (109 nd 57%) respetively ompring to prolonged exerise, the perentge ws urrently lower ontrol. y 20.7% ompred to ontrol. While tretment y Rehydrn-n nd Rehydrn-n+ (Mg+C) itrte enhne DISCUSSION the levels of hloride in oth groups y (5.6 nd 0.4%). Moreover Mg ions deresed signifintly (P 0.05) in The present results re in ordne with the exerised group y -18.6%. While Rehydrn-n nd exhusted exerised rtsresulted in n inresed growth Rehydrn-n+ (Mg+C) itrte tretment inresed the in serum CPK tivity. This inrese, however s mrkedly level y (4.91 nd 18.4%) in oth groups respetively redued in the rts fter dministrtion of ntioxidnt [25]. ompred to ontrol. Also lium nd phosphorous For instne, 16h exerise in rts used mrked rise in levels in tle (3) show vrile signifint inrese tivity levels of serum LDH. Inrese in serum LDH (P 0.05) y (72.3 nd 26.4%) in exerised groups tivity is minly due to relese from hert nd skeletl ompred to ontrol. There were signifint inrese musles into lood strem [26]. Moreover rotting drum in C y (8.51 nd 89.1) in groups treted y Rehydrn-n exerise in rts for 16hr resulted in inrese in LDH nd Rehydrn -n+ (Mg+C) itrte respetively. While tivities [27]. Different types of stressors use n phosphorous inresed signifintly y 34 nd 39.6% inrese in tivities of serum retine phosphokinse nd ompring to ontrol. ltte dehydrogense in humns nd nimls whih is n Fig. (3) Shows tht there ws signifint indition of tissue dmge [28]. The ute exerise derese(p 0.05) in ldosterone level in exerised group resulted in signifint inrese in LDH nd CPK. y 47.4%, while tretment y Rehydrn-n nd Rehydrn- The exhustive exerise indued musle dmge [29]. 1381

6 Exerise indued oxidtive stress ws lso repeted nd retinine levels. Dehydrtion lso indued oxidtive thoroughred rehorses fter 1000 re t mximum stress [35]. Sodium redution using hypontermi, veloity [30]. Exhusting or moderte exerise in rts my whih is one of the most ommon eletrolyte disorders. inrese retive oxygen speies (ROS) prodution Low sodium level my e triggered y indequte dietry exeeding the pity of ntioxidnt defenses [31]. intke of sodium nd importnt of drenl glnd or kidney Physil exerise my led to inrese in reltive weight of funtion [36]. The ville evidene indites tht the hert nd myoytes hypertrophy. The hert is not the only eletrolyte tht should e dded to drinks onsumed only orgn tht presents dpttion ltertion fter during exerise is sodium, whih is usully dded in the exerising [32]. Dily intensive exerise used form of sodium hloride. Extr slting of food is n hypertrophy in the left ventriulr hert wll nd effetive strongly for thletes living nd trining hrd in originted ollgen deposition in the right ventrile. hot wether onditions [37]. Wter is not the idel post- Additionlly long-term intensive exerise indued exerise restortion of fluid lne.it hs een signifint inrese in messenger RNA expression nd demonstrted tht drink's sodium onentrtion is more protein synthesis of the mjor firoti mrkers in oth importnt thn its osmoti ontent for inresing plsm tri nd in the right ventrile [33]. volume fter dehydrtion [10]. Eletrolyte normlities re frequent nd The ells relese potssium into the lood strem nd potentilly hzrdous omplition in hert filure. This serum levels rise with exerise, possily instigting my e due to the pthophysiologil ltertions seen in ftigue. Sodium is the mjor ion in the extrellulr fluid the hert filure stte leding to neurohumorl tivtion ut potssium is the mjor ion the intrellulr fluid. (stimultion of the renin-ngiotensin-ldosterone system. Potssium my therefore e importnt in hieving Hert filure my exhiit hypontremi due to derese rehydrtion y iding retention of wter in the intrellulr in wter exretion. Along with potssium nd lium, spe [38]. The rte of reovery ws slowest when the mgnesium influenes rdiovsulr funtion. KCl ws onsumed. The exerise indues loss of Mgnesium nd potssium defiienies ply n importnt intrellulr potssium nd inrese the extrellulr role in the development of rdi rrhythmis [6]. potssium, with the hnges in intr or extrellulr Mgnesium is essentil for the mintenne of potssium onentrtion likely to influene fore intrellulr potssium onentrtion. Although there re development. Clium loss ws lso reported during onfliting dt regrding the prevlene of strenuous exerised [39]. Also the present dt re hypomgnesemi led to hroni hert filure thn in oinident with results of hevy exerise whih inrese norml ontrols. As mgnesium nd potssium re minly potssium level [10]. intrellulr ions. There ws no orreltion etween the Furthermore, the histopthologil nlyses showed intrellulr eletrolyte ontent nd the eletrolyte levels moderte ongestion of the kidneys of trined nimls t in plsm, either for mononuler ells or erythroytes or high intensity nd moderte renl ongestion. The renl for myordil nd skeletl musle. Low mgnesium nd responses to physil exerises re relted to their potssium onentrtions inrese rdi glyoside intensity, therefore, exerises performed t low intensities toxiity. In ontrst, elevted levels of mgnesium inrese the urinry flow nd the sodium exretion., derese the sensitivity of humn myordium to nti- Atully the primry funtion of the kidneys is to regulte rrhythmogeni tions of rdi glyosides, without the volume nd omposition of the extr ellulr liquid nd ffeting mximlly developed tension. The ntirrhythmi hene, these ltertions tht our during the performne tion of mgnesium is suspeted to e medited y of physil exerises my generte hemodynmi hnges redued sensitivity to eletrophysiologil hnges nd hnges in the sodium nd wter exretion. These indued y C, thus inditing C ntgonisti findings onerning the kidneys the trined nimls properties of mgnesium. Mgnesium defiieny hs lso showing derese in the numer of glomerulus whih een implited in sudden deth. Therefore, when treting used y the hypoxi onditions imposed y the ongestive hert filure, one must onsider how to exerises [34]. prevent depletion of eletrolytes or how to replete Hypohloremi usully ours s result of sodium potssium nd mgnesium in defiieny sttes [34]. nd potssium depletion, whih used musle lesion or The dehydrtion in ody dereses urinry exretion spsm [40]. Hypomgnisum my use musle wekness. nd llows ure nd other protein wste produts to Mgnesium is lost in swet nd implited in musle umulte in the lood nd my led to inrese in ure rmp. There n e deline in plsm onentrtion in 1382

7 exerise [10]. C levels my e elevted ording to ldosterone, hormone whih progressively inreses, exessive use of lium ontining supplements. rehing up to six times more thn the indies oserved in Hyperphosphotemi use musle spsms nd rmps resting odies, s mens of keeping the ody liquids nd [40]. Hypoliumi my use musle rmps. the homeostsi [34]. Severl reports hve shown tht durtion nd/ or intensity of exerise eliit different effets on minerls CONCLUSION metolism nd tht indequte sttus of the ody minerl omposition n led to diminution of It is reommended for thletes to drink plin wter performne nd endurne oth in sportsmen nd rts etter thn drinking nothing, ut drinking properly for [41]. The drinking of rohydrte-eletrolyte inresed mintined rohydrte eletrolyte sports drink will llow N nd K ions in lood. Thus in terms of minimizing for n even etter exerise performne. physiologil disturnes. Also d liitum drinking everge ws s effetive s drinking wter during ACKNOWLEDGEMENT exerise ut ws more effetive in reovery [42]. After + + exerise-indued dehydrtion serum eletrolyte N, K The uthors knowledge the expert ssistne - nd Cl onentrtion fell. While fter ingestion of drinks rendered y Dr. Kwk Ad El-Aziz Ahmed, Professor sujets were in greter net fluid lne [43]. of Veterinry Mediine, Ciro University for performing The tretment with rehydrte (frutose, gluose histopthologil exmintions nd interprettions. polymer, lium, mgnesium, sodium, potssium, mino ids nd vitmins) resulted in inrese in tredmill time REFERENCES reltive to tht of the dehydrted stte. The results indite tht onstituents other thn wter, simple 1. Dimeff, R.J., Seizure disorder in professionl trnsportle monoshrides nd sodium re importnt Amerin footll plyer. Curr. Sports Med. Rep., for mximl exerise performne nd effetive reovery 5: ssoited with endurne exerised-indued dehydrtion 2. Godex, S.F., A.R. Brtolozzi nd J.J. Godex, [44]. Postexerise hydrtion should im to orret ny Swet rte nd fluid turnover in Amerin footll fluid loss umulted during the prtie or event. plyers ompred with runners in hot nd humid Idelly ompleted within 2 hours, rehydrtion should environment. Br. J. Sports Med., 39: ontin wter to restore hydrtion sttus, rohydrtes 3. Brtok, C., D.A. Shoeller, J.C. Sulivn, R.R. Clrk nd to replenish glyogen stores nd eletrolytes to speed G.L. Lndry, Hydrtion testing in ollegite rehydrtion [45]. wrestlers undergoing hypertoni dehydrtion. Med. Severl studies reported tht the hief funtion of Si. Sports Exer, 36: ldosterone is the regultion of eletrolyte. It regultes 4. Merson, S.J., S.M. Shirreffs, J.B. Leiper nd slt lne. It inreses sodium resorption nd R.J. Mughn, Chnges in lood, plsm nd seretion of potssium y the kidney tuules. It is red ell volume fter ingestion of hypotoni nd minerloortioid hormone. The rte of inrese plsm hypertoni solutions. Pro. Nutr. So., 61: 108A. ldosterone s potssium rises in serum is not muh lower 5. Nokes, T.D., Overonsumption of fluids y t high sodium intkes. Thus the potssium is strongly thletes. BMJ., 327: regulted t ll sodium intkes y ldosterone when the 6. Mithell, H.R. nd K. Justin, supply of potssium is dequte [46]. The plsm vlue of Exerised-Assoited Hypontremi. Clin. J. Am. ldosterone one dy fter exerise ws signifintly So. Nephrol., 2: lowered in footll plyers. On the other hnd the pre- 7. Mirhell, J.B., M.O. Phillips, S.P. Merer, H.L. Bylies exerise ingestion of sodium itrte resulted in derese nd F.X. Pizz, Post exerise rehydrtion effet in serum ldosterone. The oserved effet of N+ on + of N nd volume on restortion of fluid spes serum ldosterone level my e medited y n ute nd rdiovsulr funtion. J. Appl. Physiol., inrese in plsm volume nd serum N+ onentrtion 89: ltertion [47]. The hypohydrtion leds to ltertions in 8. Twerenold, R., B. Knehtle, T.H. Kkeeeke, seretion of ll fluid nd eletrolyte hormone. The speifi P. Eser, G. Müller, P. von Arx nd H. Kneht, mehnisms of these ltertions pper to e relted Effets of different sodium onentrtions in diretly to the derese in plsm volume [48]. Mye replement fluids during prolonged exerise in suh derese is due to the high plsmti indies of women. Br J. sport Med., 37:

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