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KOKODA TRACK SAFETY PACKAGE:
RESEARCH PROJECT: POSSIBLE HYDRATION RELATED ILLNESS IN TREKKERS ON THE KOKODA TRACK
In early 2010, a non-profit advisory group Adventure Medicine submitted a proposal to the Kokoda Track Authority for assistance to conduct important research on the Kokoda Track to examine the possibility of hydration related illness in trekkers.
This proposal was considered by the PNG and Australian Governments and was determined appropriate to be funded under the joint Kokoda Track Safety Package. The Adventure Medicine research team conducted the study on the Kokoda Track from 16 to 19 April 2010.
What did the research find?
The aim of the study was to determine the number of individuals on the Kokoda Track who develop low salt levels. Most of the trekkers had normal blood tests results. However, a small number of them did have low salt levels. These trekkers had consumed a large amount of fluid. Fortunately their salt levels were not dangerously low and the doctors were able to intervene and educate the trekkers about the affects of drinking too much fluid.
This study has confirmed that a small number of people can drink too much fluid and potentially become unwell from low salt in their blood, particularly while undertaking arduous treks.
The best way to avoid this is to drink when you are thirsty. Obviously drink enough fluids to prevent dehydration, but don't overdo it!
Why is this research important?
The Kokoda Track has gained increasing popularity for Australian travellers over the last decade. However, as more individuals undergo this challenging trek there has been an increase in the number of people who develop medical complications associated with strenuous exercise.
In 2006 and 2008 there were two reports of healthy trekkers becoming ill because of extremely low salt levels in their blood. Low salt levels occur because individuals drink too much water while exercising. This can lead to serious illness and even death if left untreated.
In the majority of cases trekkers have completed appropriate pre-trek fitness training and obtained necessary medical clearance. However, this type of research helps us to educate tour operators and trekkers about potential problems that can occur while undertaking this type of activity and ways they can reduce these risks.
How was the research conducted?
Three investigators entered the Kokoda Track from Owers Corner and three entered from Kokoda. The two teams of investigators trekked for two days and set up camp in Ioribaiwa Village and Isurava to collect data.
All trekkers who passed the researchers camp on the second day of their trek were approached and asked to volunteer to participate in the study. Almost all trekkers decided to participate, providing researchers with a sample size of nearly 200. Participants answered a brief medical questionnaire and provided a blood sample for immediate analysis.
Who conducted the research?
The principle investigators are Dr Sean Rothwell and Dr David Rosengren from Adventure Medicine. Both are specialist emergency physicians at the Royal Brisbane and Women's Hospital and Greenslopes Private Hospital and they also hold Fellowships from the Academy of Wilderness Medicine. The remainder of the research team is made up of Royal Brisbane and Women's Hospital emergency physicians, Dr Julian Williams and Dr Bill Lukin, Emergency Registrar from Port Moresby Hospital, Dr Julius Plinduo, University of Queensland Professor Allan Frost and barrister and former battalion Commanding Officer Mr David Thomae.
Is this research certified?
The research project is approved by the Research Ethics Committee at the Royal Brisbane and Womens Hospital.
What next?
The results of the study will be submitted for publication and also used to educate trekking companies and future trekkers in the prevention of this condition.
The KTA and Adventure Medicine will continue to work together to produce information for tour operators and trekkers to include in pre-departure safety information.
Additional information
This project is funded by the Australian Government through the joint PNG-Australia Kokoda Track Safety Package, managed by the Kokoda Track Authority (KTA). The Royal Brisbane and Womens Hospital have also supported the research through providing personnel and loaning two of the iSTAT machines and providing invaluable logistical support. Medical equipment has been donated by Abbott Point-of-Care, Abacus ALS and Queensland Health.
Contact
For more information about the research, contact the research team at http://www.adventuremedicine.net/about-us or phone Dr David Rosengren 0417615223 or Dr Sean Rothwell 0417761281
Or contact the Kokoda Track Authority CEO at email ceo@kokodatrackauthority.org Kokoda Track Safety Package
The Australian and Papua New Guinean Governments are working together to implement a range of safety projects along the Track. This includes a major upgrade of the Owers Corner Road, repairs to other local roads and bridges, safety enhancements at airstrips, improvements to radio communications, assessments of health issues and subsidised first aid training.
$4.9 million in funding has been allocated for these important infrastructure and safety projects, which will benefit local communities and trekkers.
Find out more at http://www.environment.gov.au/heritage/int…koda/index.html
KTA_Logo.jpeg"This study has confirmed that a small number of people can drink too much fluid and potentially become unwell from low salt in their blood, particularly while undertaking arduous treks.
The best way to avoid this is to drink when you are thirsty."
Well this is interesting…
What if a) the fluid you are drinking has magnesium + extra salt in it to compensate or b ) you take salt-replacement tablets each day to replace the salt lost in your sweat???
Also, according to my G.P, my personal trainer, my gymnastics coach and my physio – by the time you realise you are thirsty, it is often too late and you are already dehydrated. Either all four of my health professionals have got it wrong or there is some serious myth-busting to do…
fluppy
Congratulations to the Kokoda Track Authority and to the Governments of Austalia and PNG for funding the study of such an important area of research. Well done to the researchers for such an innovative project. Evidence based research on such an important topic has been needed and has the capacity to give important information about the health and fitness on a cohort of Kokoda trekkers.
The study also highlights that it is important for trekkers to drink when they are thirsty(or when they feel they need it). Prescriptive fluid volumes every 15 or 30 minutes or excessive fluid intakes are inherently dangerous and unnecessary as pointed out in the research summary.
In hot and humid conditions trekkers are losing sodium through sweating.Elecrolyte imbalance is further worsened when large amounts of water is consumed by someone who is already sodium depleted.When the body is losing sodium ,ADH(anti diuretic hormone) is released at increased levels.The kidneys are producing concentrated urine but the body is retaining as much water as possible. The result is not good for electrolyte balance. Serious electrolyte imbalance can lead in its most extreme form to cardiac arrest.
Evidence based research that may assist in the management of fluid/electrolyte balance for people undertaking arduous treks in harsh climates has to be a plus.Previous research has shown that appropriate levels of elecrolyte supplements and foods higher in sodium can assist those people whose sodium level is depleted.
Hyponatraemia is not going to be diagnosed clinically for any trekker without a blood test. Not possible in most Kokoda situations.
Myth busting is not necessary in looking at this issue. Whilst the anecdotal opinion of sports trainers/coaches/physios may be of interest to some, evidence based research supported by previously published research lierature hold much more credibility.
Well done to all associated with the projectPete
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