25 year old body builder presents with weakness and fatigue

Metabolic Alkalosis – pH 7.65 HCO3 40mmol/l

Respiratory Compensation Expected PCO2 = (0.7xHCO3)+20 =48mmHg

Low K and Na, normal creatinine, mildly elevate BSL

The above VBG shows a compensated metabolic alkalosis, with a moderately low K, mildly decreased sodium and a mildly elevated BSL. The most common causes of a metabolic alkalosis are vomiting, diuretics and increased aldosterone (Recall CLEVERRPD for all causes). In this clinical context the most likely causes of the alkalosis would be diuretic abuse leading to volume contraction and would also account for the electrolyte disturbances. Other drugs that need to be considered would be anabolic steroids as well as glucocorticoids. The glucocorticoids can lead to Cushings syndrome that can present with a metabolc alkalosis. The low potassium can be multifactorial – alkalosis, diuretic abuse and steroid abuse.

Drug use in Body Builders:

Androgens – including exogenous testosterone, androgenic steroids, selective androgen receptor modulators, antioestrogens. Complications: increase in LDL and decrease in HDL, erythropoiesis, cardiac hypertrophy leading to SCD, neuropsychiatric disorders, hypogonadism, infection, tendon rupture, hepatic effects including cholestatic jaundice, hepatomas and abnormal liver function

Growth Hormone -causing insulin resistance, hyperglycaemia, sodium retention, hypertension, cardiomegaly.

Glucocorticoids – hyperglycaemia, fluid retention, osteoporosis, muscle mass decrease, diabetes, hypertension, cataracts, psychiatric symptoms, abdominal obesity.

Diuretic abuse to dilute banned substances in the urine and treat fluid retention from steroid use. Complications: dehydration, electrolyte disturbances

Stimulants – MDMA, amphetamines