Key result
Triamterene/HCTZ self-medication and fluid restriction linked to severe hypokalemia, quadriparesis, and 625 ms QTc.
Why the study?
Severe hypokalemia with neurological impairment and ECG abnormalities due to misuse of triamterene/hydrochlorothiazide in a bodybuilder had not been reported.
Case Report (n=1)
Self-medication with diuretics such as triamterene/hydrochlorothiazide combined with fluid restriction in bodybuilders can cause severe hypokalemia, paralysis, and dangerous ECG abnormalities.
Answers are grounded in this paper and cite their sources.
Clinicians should consider diuretic self-medication in bodybuilders with paralysis or prolonged QTc; case reports leave open prevalence and screening needs.
BACKGROUND: Severe hypokalemia with severe neurological impairment and electrocardiogram (ECG) abnormalities due to the misuse of triamterene/hydrochlorothiazide (HCTZ) in a bodybuilder has not yet been reported. CASE REPORT: A 22-year-old bodybuilder developed acute generalized muscle cramps, sensory disturbance of the distal lower and upper limbs, quadriparesis, and urinary retention. These abnormalities were attributed to severe hypokalemia of 1.8 mmol/L (normal range 3.4-4.5 mmol/L) due to misuse of triamterene/HCTZ together with fluid restriction. He was cardiologically asymptomatic, but ECG revealed a corrected QT (QTc) interval of 625 ms. On intravenous application of fluids along with intravenous and oral substitution of potassium, his condition rapidly improved, such that the sensory disturbances, quadriparesis, and bladder dysfunction completely resolved within 2 days after admission. CONCLUSIONS: Self-medication with diuretics along with fluid restriction may result in severe hypokalemia, paralysis, and ECG abnormalities. Those responsible for the management of bodybuilding studios and competitions must be aware of the potential severe health threats caused by self-medication with diuretics and anabolic steroids. Although triamterene is potassium-sparing, it may enhance the potassium-lowering effect of HCTZ.
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Pfisterer et al. (2019) conducted a case report in Severe acquired hypokalemic paralysis (n=1). Triamterene/hydrochlorothiazide (HCTZ) and fluid restriction was evaluated on Severe hypokalemia, neurological impairment, and ECG abnormalities. Self-medication with triamterene/hydrochlorothiazide and fluid restriction in a 22-year-old bodybuilder resulted in severe hypokalemia (1.8 mmol/L), quadriparesis, and a QTc interval of 625 ms.
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