474 THE JOURNAL OF SCHOOL HEALTH

FOR THE MEDICAL DIRECTOR I JOHN LAMPE, M.D. AND EVALYN S. GENDEL, M.D. I

Electrolytes and Exercise

The metabolic processes associatcd with muscular activity has hccn studied in physiology laboratories for many years. Knowledge from such research has been utilized clinically in a variety of ways. For example, the treatment of diabetes depends upon an understanding of carbohydrates metabolism. No one would question the importance of such fundamciital research nor fail to appreciate its clinical application. The application of similar knowledge to activity associated with athletics is not as dramatic as in the instance of diabetes and is sometimes overlooked or forgotten. The explanation of some troublesome problems and the basis for certain time honored customs may indeed be found in the physiology of exercise.

Recent studies relating to electrolytes and cardiac functions arc ex- amples. The shift of potassium to the extra cellular space (plasma) under exercise has been known for some time. Also well known is the peaking of T waves on the electrocardiogram that accompanies exercise. Modern recording techniques as well as increased sophistication in elec- trolytic analysis has permitted the establishment of a relationship betwecn these two observations. Similarly, sodium and calcium levels were shown to have no effect on the T wave. Training seemed to increase the effect. The mobilization of potassium has an important effect hence i t is 1ogic:il to believe that electrolytes in general are worthy of consideration in activity. Empirically calcium has been prescribed in treatment of muscle cramps for years. Soldium chloride has a well established use in increased environmental temperatures. This sort of knowledge comes to have a new aspect in optimal performance. The availability of mineral com- ponents in the diet offers opportunity for enhancing performancc by better dietary based upon physiological research.

Further information about electrolytes and exercise can bc obtained from reading an article by I<. D. Rose and associates in the January 10, 1966 issue of the J A M A (195: 2 : 111).

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T h e Problems of Confidential Information As in other areas in the practice of medicine, the handling of con-

fidential information from time to time gives the school physicim or his :mociates pause for reflection. The ideas that we have are based on principles taught us in our training years, past experiences, common knowledge, understanding of ethicd tind legal requirements of our pro- fession and practice in the current situation. Unfortunately, on occasioii our ideas are not i n accord with those of other individuals concerned. The importance of confidentiality is obvious to all. Relations with pupils in particular are frequently predicated upon the assumption that informn-

THE JOURNAL OF SCHOOL HEALTH 475

tion disclosed will be regarded as confidential. Upon occasion this is equally true in work with adult personnel. Respect for this confidence is essential for continuation of rapport and in large measure for con- structive help in many cases. School health information should be regarded as is general health information throughout the practice of medicine and safeguards instituted to insure its confidentiality. Ideally, health records are filed separately from other pupil records and are kept under lock and key with the school nurse responsible for their care. Adult records are handled similarly in that they are not kept with other personnel dtzta but are the responsibility of the school health personnel. Acces- sibility to such records is restricted. Due consideration must be given to the obligation to make such information as is necessary available to other school personnel concerned. Procedures and practices must bc developed by which these dual obligations are discharged to the advantage of all concerned and with full respect for their confidential nature. It is here that problems sometimes arise.

What is the school doctor to do when told by a pupil that he suspects that he has a venereal disease? How does one handle the situation when informed by a teacher that in periods of depression she has contemplated suicide? Such exnmplcs as these may have apparent solutions but every- one in the field of school health has encountered some such situation in which he or shc is a t a loss to know what is really optimal, ethical, and legal.

Much has been written about this subject in both medical and legal publications. There arc some guide lines which are of value. An article in the JAML4 (182: 6: 160, Nov. 10, 1962) reviewed and summarized the situation well with particular emphasis on emotional problems and psy- chiatric patients. It is well worth review.

In addition, deference must be given to local practice. Legal require- ments in the arca of public records are in the process of change. The issue of individual rights has affected this area as it has others in recent years. Those responsible for health records would be well advised to avail them- selves of help in their communities. Individuals from the legal profes- sion, from the medical community and from the school district meeting together can pl:~n thc handling of school health records as regards con- fidentiality :~nd so forestall difficulties. The effort will add significantly to the service offered and should a problem arise be of material value to the school health personnel.

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