Man develops quadriparesis after taking drug concoction given by his gym trainer: Case report

A 33-years old patient experienced the onset of acute quadriparesis after taking drugs illicitly given by his gym trainer, reported a case study published in the Journal of Association of Physicians of India (JAPI). This case served as an eye-opener for fitness-seekers who blindly entrust their health in the hands of unqualified ‘wellness coaches’ and highlights the importance of rigorous and thorough history-taking for doctors as it may provide a clue for diagnosis.

We live in an era where everyone wants to look attractive and in order to achieve that they can go up to any extent without even caring about their life. Bodybuilding has become a craze for youngsters. People are often seen blindly surrendering to their gym trainer's advice, as a result, they become easy prey to their business tactics. Something similar happened in this case as well.

According to the case study, a 33 years male reported complaints of sudden onset weakness in all four limbs in the form of inability to stand from squatting position, inability to button his shirt or hold the teacup for a day. On the previous day, he developed sudden onset weakness of all four limbs, which were total at onset and non-progressive. He was unable to stand up from the floor bed or walk without support. The weakness had not improved with the medications dispensed by his family physician.

Upon asking for his health status, if he had any past illness, he denied any history of preceding febrile illness or vaccination. There was no history of similar episodes in the past. He informed us that, in order to gain weight, he had enrolled in a gym 13 months ago. But at that point, he denied consumption of any herbal, ayurvedic or diuretic drugs. He admitted that he had gained 15 kilograms weight in the past year after enrolling in the gym. After repeated grilling about illicit drug intake, his wife revealed that he had been taking some medicines on the advice of his gym instructor for the past thirteen months. She was immediately advised by us to make the tablets available for scrutiny.

On examination of the young male, the authors recorded stable vital parameters except for tachypnoea. On nervous system examination, higher functions and cranial nerves were normal. the authors found MRC grade 3 power in distal muscle and grade 2 power in proximal muscles of both upper and lower limbs. Tendon reflexes were not elicited even with reinforcement. No sensory or autonomic abnormalities were detected.

His ECG showed a heart rate of 70 beats per minute, prolonged QT interval (QTc= 504 ms), widened QRS complexes (0.12 seconds) and prominent U waves in anterior leads (Figure 1 A) Blood sugar was 112 mg/dl, Thyroid function was normal. Serum potassium levels were remarkably low i.e. 1.9 meq (normal 3.5 to 5.6 meq/dl). He was admitted to the intensive care unit and under cardiac monitoring, potassium chloride infusion in Mannitol was started by the intravenous route. At the end of six-hour of admission power in all limbs had returned to Grade 5. The serum potassium level was 3.9 mEq/dl. The electrocardiogram showed regression of U waves and normalization of QRS duration (0.10 seconds) (Figure 1B and 1C). By then, the offending tablets were made available and found to be containing Cyproheptadine 4 mg and Dexamethasone 0.5 mg (Figure 2). This was corroborated on the next day by the gymnasium trainer as well. The patient was counseled about the avoidance of such quick-fix remedies in the future. On follow-up, he is found to be in good health without any residual weakness.

Explaining what might have caused quadriparesis this patient the authors stated that steroid-induced hyperinsulinemia leads to an increased NA+/K+ -ATPase pool in the skeletal muscle. This exacerbates hypokalemia by promoting the renal excretion of potassium, resulting in muscle weakness. Dexamethasone which doesn’t have mineralocorticoid effects may cause paralysis by this method.

"Our case highlights the importance of rigorous and thorough history-taking for there-in lies the clues to the diagnosis. This case should also serve an eye-opener for fitness-seekers who blindly entrust their health in the hands of unqualified ‘wellness coaches’." conclude the authors.

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‘Gym Tonic’ and Quadriparesis, Himmatrao S Bawaskar, Parag H Bawaskar, Pramodini H Bawaskar. Available at japi.org