bodybuilding is the use of progressive resistance exercise , and it involves drastic reductions in body fat while maintaining muscle mass .
there is a tendency to think that there is a magic powder or supplement that will give you the physique of your dreams , but there is no substitute for hard work , commitment , and good diet .
it has beneficial effects also in terms of lower long - term disease risk but doing unscrupulously can be harmful and may lead to more severe illnesses , injury and even mortality .
a 35-year - old male who presented to us with a history of severe pain in both thigh and unable to walk for last around 3 days after having strenuous exercise activity in the gym .
he also had vomiting and decrease oral in take thereafter . though he was a regular visitor to the gym but he did a new exercise in the form of more than 500 sit - ups . before visiting us , he took consultation outside and received analgesics but little relief in pain . on admission , he was conscious , maintaining vitals and having pain and tenderness in both thigh .
laboratory evaluation at time of admission showed hemoglobin ( hb ) 14.8 g / dl , total leukocyte count 12,400 , urea 128 mg / dl , serum creatinine 4.8 mg / dl , sodium 133 mmol / l , potassium 4.55 mmol / l , calcium 7.8 mg / dl , creatine phosphokinase ( cpk ) 87,000 u / l , total bilirubin 1.2 mg / dl , serum glutamic oxaloacetic transaminase ( sgot ) 1160 u / l , serum glutamic pyruvic transaminase ( sgpt ) 404 .
diagnosis of rhabdomyolysis due to strenuous exercise leading to acute kidney injury was made based on the temporal profile , clinical presentation , lab reports and ruling out other common causes like severe sepsis .
though he was improving , but he opted to shift to some other hospital of his nearby area . a 28-year - old male who was regular at the gym for bodybuilding presented to us with 1-day history of epigastric pain radiating to back , recurrent vomiting and abdominal distension . on admission
his heart rate was 160 per min regular , respiratory rate was around 40 per min , blood pressure 100/80 mmhg , abdomen was diffusely distended and mildly tender .
initial lab evaluation showed hb 18.7 g / dl , total leukocycte count 6200 , serum creatinine 0.8 mg / dl , urea 34 mg / dl , sodium 138 , potassium 4.3 mmol / l , total protein 6.1 g / dl , albumin 3.7 g / dl , sgot 29 , sgpt 26 , alkaline phosphatase 145 , lipase 104 , serum amylase 760 u / l , prothrombin time ( international normalized ratio ) 1.23 , activated partial thromboplastin time 38 s , serum calcium 9.4 mg / dl , serum triglyceride 148 mg / dl .
arterial blood gas analysis reveal ph 7.33 , pco235 , po280 mmhg on oxygen through face mask at 8 l / min , lactate 3.7 mmol / l . on ultrasonography abdomen ,
pancreas was swollen with mild peritoneal collection , diffuses inflammatory changes with no evidence of gall stones or biliary sludge . on detailed history including alcohol intake and examination we could not find obvious reason of acute pancreatitis other than his history of taking androgenic anabolic steroids ( aas ) and protein supplements for body building since other less common causes which includes hypercalcemia , hypertriglyceridemia or post - endoscopic retrograde cholangiopancreatography was also not there and corticosteroids are known etiological agent for acute pancreatitis . after initial improvement over the period of 57 days patient 's condition start worsening again , and he was shifted to bigger center where he died after 23 days .
an 18-year - old male presented to us with a history of 1-day of stiffness of jaw , neck , back and difficulty in swallowing .
there was also associated history of sweating over face and neck . over the next few hours , he developed frequent sudden jerky movement of the body . as he developed spasm and hypoxia ,
he was requiring paralyzing agent in addition to diazepam infusion because of severe and frequent tetanic spasm .
there was no history of fever , no evidence of poisoning or trauma , but he was on self - medication as part of body building and taking regular intramuscular injection of anabolic steroid . in the absence of any other clue , we attributed tetanus due to intramuscular injections .
he remained on a ventilator with a paralyzing medication for more than 4 weeks with daily interruption of paralysis to observe for tetanic spasm .
a 35-year - old male who presented to us with a history of severe pain in both thigh and unable to walk for last around 3 days after having strenuous exercise activity in the gym .
he also had vomiting and decrease oral in take thereafter . though he was a regular visitor to the gym but he did a new exercise in the form of more than 500 sit - ups . before visiting us , he took consultation outside and received analgesics but little relief in pain . on admission , he was conscious , maintaining vitals and having pain and tenderness in both thigh .
laboratory evaluation at time of admission showed hemoglobin ( hb ) 14.8 g / dl , total leukocyte count 12,400 , urea 128 mg / dl , serum creatinine 4.8 mg / dl , sodium 133 mmol / l , potassium 4.55 mmol / l , calcium 7.8 mg / dl , creatine phosphokinase ( cpk ) 87,000 u / l , total bilirubin 1.2 mg / dl , serum glutamic oxaloacetic transaminase ( sgot ) 1160 u / l , serum glutamic pyruvic transaminase ( sgpt ) 404 .
diagnosis of rhabdomyolysis due to strenuous exercise leading to acute kidney injury was made based on the temporal profile , clinical presentation , lab reports and ruling out other common causes like severe sepsis .
though he was improving , but he opted to shift to some other hospital of his nearby area . a 28-year - old male who was regular at the gym for bodybuilding presented to us with 1-day history of epigastric pain radiating to back , recurrent vomiting and abdominal distension . on admission
his heart rate was 160 per min regular , respiratory rate was around 40 per min , blood pressure 100/80 mmhg , abdomen was diffusely distended and mildly tender .
initial lab evaluation showed hb 18.7 g / dl , total leukocycte count 6200 , serum creatinine 0.8 mg / dl , urea 34 mg / dl , sodium 138 , potassium 4.3 mmol / l , total protein 6.1 g / dl , albumin 3.7 g / dl , sgot 29 , sgpt 26 , alkaline phosphatase 145 , lipase 104 , serum amylase 760 u / l , prothrombin time ( international normalized ratio ) 1.23 , activated partial thromboplastin time 38 s , serum calcium 9.4 mg / dl , serum triglyceride 148 mg / dl .
arterial blood gas analysis reveal ph 7.33 , pco235 , po280 mmhg on oxygen through face mask at 8 l / min , lactate 3.7 mmol / l . on ultrasonography abdomen ,
pancreas was swollen with mild peritoneal collection , diffuses inflammatory changes with no evidence of gall stones or biliary sludge . on detailed history including alcohol intake and examination we could not find obvious reason of acute pancreatitis other than his history of taking androgenic anabolic steroids ( aas ) and protein supplements for body building since other less common causes which includes hypercalcemia , hypertriglyceridemia or post - endoscopic retrograde cholangiopancreatography was also not there and corticosteroids are known etiological agent for acute pancreatitis . after initial improvement over the period of 57 days patient 's condition start worsening again , and he was shifted to bigger center where he died after 23 days .
an 18-year - old male presented to us with a history of 1-day of stiffness of jaw , neck , back and difficulty in swallowing .
there was also associated history of sweating over face and neck . over the next few hours , he developed frequent sudden jerky movement of the body . as he developed spasm and hypoxia ,
he was requiring paralyzing agent in addition to diazepam infusion because of severe and frequent tetanic spasm .
there was no history of fever , no evidence of poisoning or trauma , but he was on self - medication as part of body building and taking regular intramuscular injection of anabolic steroid . in the absence of any other clue , we attributed tetanus due to intramuscular injections .
he remained on a ventilator with a paralyzing medication for more than 4 weeks with daily interruption of paralysis to observe for tetanic spasm .
a 35-year - old male who presented to us with a history of severe pain in both thigh and unable to walk for last around 3 days after having strenuous exercise activity in the gym .
he also had vomiting and decrease oral in take thereafter . though he was a regular visitor to the gym but he did a new exercise in the form of more than 500 sit - ups . before visiting us , he took consultation outside and received analgesics but little relief in pain . on admission , he was conscious , maintaining vitals and having pain and tenderness in both thigh .
laboratory evaluation at time of admission showed hemoglobin ( hb ) 14.8 g / dl , total leukocyte count 12,400 , urea 128 mg / dl , serum creatinine 4.8 mg / dl , sodium 133 mmol / l , potassium 4.55 mmol / l , calcium 7.8 mg / dl , creatine phosphokinase ( cpk ) 87,000 u / l , total bilirubin 1.2 mg / dl , serum glutamic oxaloacetic transaminase ( sgot ) 1160 u / l , serum glutamic pyruvic transaminase ( sgpt ) 404 .
diagnosis of rhabdomyolysis due to strenuous exercise leading to acute kidney injury was made based on the temporal profile , clinical presentation , lab reports and ruling out other common causes like severe sepsis .
though he was improving , but he opted to shift to some other hospital of his nearby area .
a 28-year - old male who was regular at the gym for bodybuilding presented to us with 1-day history of epigastric pain radiating to back , recurrent vomiting and abdominal distension . on admission
his heart rate was 160 per min regular , respiratory rate was around 40 per min , blood pressure 100/80 mmhg , abdomen was diffusely distended and mildly tender .
initial lab evaluation showed hb 18.7 g / dl , total leukocycte count 6200 , serum creatinine 0.8 mg / dl , urea 34 mg / dl , sodium 138 , potassium 4.3 mmol / l , total protein 6.1 g / dl , albumin 3.7 g / dl , sgot 29 , sgpt 26 , alkaline phosphatase 145 , lipase 104 , serum amylase 760 u / l , prothrombin time ( international normalized ratio ) 1.23 , activated partial thromboplastin time 38 s , serum calcium 9.4 mg / dl , serum triglyceride 148 mg / dl .
arterial blood gas analysis reveal ph 7.33 , pco235 , po280 mmhg on oxygen through face mask at 8 l / min , lactate 3.7 mmol / l . on ultrasonography abdomen ,
pancreas was swollen with mild peritoneal collection , diffuses inflammatory changes with no evidence of gall stones or biliary sludge . on detailed history including alcohol intake and examination we could not find obvious reason of acute pancreatitis other than his history of taking androgenic anabolic steroids ( aas ) and protein supplements for body building since other less common causes which includes hypercalcemia , hypertriglyceridemia or post - endoscopic retrograde cholangiopancreatography was also not there and corticosteroids are known etiological agent for acute pancreatitis . after initial improvement over the period of 57 days patient 's condition start worsening again , and he was shifted to bigger center where he died after 23 days .
an 18-year - old male presented to us with a history of 1-day of stiffness of jaw , neck , back and difficulty in swallowing . there was also associated history of sweating over face and neck . over the next few hours , he developed frequent sudden jerky movement of the body . as he developed spasm and hypoxia ,
he was requiring paralyzing agent in addition to diazepam infusion because of severe and frequent tetanic spasm .
there was no history of fever , no evidence of poisoning or trauma , but he was on self - medication as part of body building and taking regular intramuscular injection of anabolic steroid . in the absence of any other clue , we attributed tetanus due to intramuscular injections .
he remained on a ventilator with a paralyzing medication for more than 4 weeks with daily interruption of paralysis to observe for tetanic spasm .
it was suspected on the basis of high - intensity exercise in otherwise routine gym visitor , followed by pain in both thigh with tenderness , deranged lab reports which include very high level of cpk , alanine and aspartate aminotransferases , low level of calcium and after exclusion of other common causes including severe sepsis .
rhabdomyolysis may develop in an individual after strenuous activity even who are athlete as it was in our patient .
he did more than 500 sit - ups at stretch that too first time along with his daily gym activity .
moreover , he took analgesics for muscle pain , which in association with poor oral intake worsens acute kidney damage .
exertional rhabdomyolysis is more likely to occur when strenuous exercise is performed under high temperatures and humidity .
other factors include improper hydration , inadequate recovery between bouts of exercise , intense physical training , and inadequate fitness levels for beginning high - intensity workouts . as he did his activity in the gym
intense physical training and inadequate fitness level for beginning high - intensity workouts appear to be more logical explanation for rhabdomyolysis in our patient .
rhabdomyolysis is an important cause of acute renal failure ( arf ) , and main pathophysiological mechanisms are renal vasoconstriction , intraluminal cast formation , and direct myoglobin toxicity .
daher ede et al . reported a similar case of rhabdomyolysis leading to acute kidney injury after strenuous exercise .
it was diagnosed on the basis of raised amylase level with ultrasonographic findings of swollen pancreas with inflammatory changes in patient of epigastric pain , which was later confirmed on computed tomography scan .
androgenic anabolic steroids have grown in popularity amongst athletics and bodybuilders due to their ability to enhance performance , muscle mass , and aesthetic reasons .
pancreatitis as a complication of aas is not much reported but of corticosteroids is well documented .
the usual causes of pancreatitis were excluded in our patient on the basis of history , lab reports , and ultrasonography .
researchers have recently discovered evidences that suggest anabolic steroids may demonstrate potentially new and serious adverse consequences .
evidence obtained from a clinical trial suggests that acute pancreatitis and acute kidney injury can be caused by the use of anabolic steroids like methandrostenolone .
reported a case of 50-year- old man who develop acute pancreatitis and acute kidney injury which was attributed to aas .
described a case report of multi - organ damage after the use of anabolic steroids .
they also suspected that besides hypercalcemia , acute pancreatitis have resulted from overuse of amino acid supplements .
arginine was shown to be a potent secretagogue for anabolic hormones in addition to inducing pancreatic acinar damage .
it was diagnosed on the basis of typical clinical picture consisting of the jaw , neck , back stiffness and difficulty in swallowing .
later on , he developed typical recurrent tetanic spasms , for which he was intubated and kept on mechanical ventilation .
he was regularly taking aas intramuscular injection as a self - prescribed and self - injected medication , as part of bodybuilding activity .
as the people engaged in bodybuilding are on a continuous rise , with more data collection or planning an observational study will help to better understand this population subset .
 bodybuilding is the use of progressive resistance exercise to control and develop one 's musculature . with the rise in number of persons adopting this activity , there is evolving paradigm of illnesses presented to intensive care in this population subset . 
 strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects . 
Introduction
Case Reports
None
Case 1
Case 2
Case 3
Discussion