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  #1  
Old 12-29-2011
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Question Female Athlete with excessive weakness!

An 18-year-old female athlete reports easy fatigability and weakness. Physical examination shows no abnormalities. Laboratory studies
show:
Na+ 141 mEq/L
Cl− 85 mEq/L
K+ 2.1 mEq/L
HCO3 − 35 mEq/L

Urine
Na+ 80 mEq/24 h
K+ 170 mEq/24 h

Which of the following is the most likely diagnosis?
(A) Aldosterone deficiency
(B) Anxiety reaction with hyperventilation
(C) Diabetic ketoacidosis
(D) Ingestion of anabolic steroids
(E) Surreptitious use of diuretics
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  #2  
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Answer is Use of diuretic.


But I cannot understand why steroid use cannot be the answer. Can anyone explain why?
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  #3  
Old 12-29-2011
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reallly nice question thanks

i searched it in books and wiki hope it helps, this what I found

Diuretics increase the amount of urine produced by the body. Some athletes use diuretics to assist them to fall within the required weight categories.
they are also used by some athletes to dilute their urine in an attempt to avoid detection of anabolic agents.
Side Effects
Athletes using diuretics run the risk of dehydrating

anabolic steriods side effects
Effects specific to females may include an increase in facial and body hair, menstrual problems, permanent deepening of the voice and clitoral enlargement
her physical examination was normal so i guess rule out anabolic steriods and also she dont have menstrual problem.

i hope someone add something more to make it complete
is this question from Uworld or kaplan coz i think i have seen it ??
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  #4  
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The athlete is having hypernatremia and hypokalemia. Now giving diuretics like loop or thiazides will initially increase sodium and pottasium excretion but in the collecting duct the sodium exchanges for potassium and H+. This will result in more potassium excretion and also will reabsorb more bicarbonate as more H+ formed in collecting duct in exchange of Na+ Excess amount can result in hypernatremia
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Quote:
Originally Posted by mohitkmc View Post
The athlete is having hypernatremia and hypokalemia.Now giving diuretics like loop or thiazides will initially increase sodium and pottasium excretion bt in the collecting duct the sodium exchanges for pottasium and H+.This will result in more potasium excretion and also will reabsorb more bicarbonate as more H+ formed in collecting duct in exchange of Na+.Excess amount cn result in hypernatremia
Point taken but even a steroid would do exactly the same and that's what i was trying to clarify
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Quote:
Originally Posted by mohitkmc View Post
The athlete is having hypernatremia and hypokalemia.Now giving diuretics like loop or thiazides will initially increase sodium and pottasium excretion bt in the collecting duct the sodium exchanges for pottasium and H+.This will result in more potasium excretion and also will reabsorb more bicarbonate as more H+ formed in collecting duct in exchange of Na+.Excess amount cn result in hypernatremia
but pt does not have hypernatremia .

i guess we shld also think of the sodium she is loosing by sweating as she is an athlete.preventing her from getting hypernatremia.

i think i m triping....
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Old 12-29-2011
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Default I go for steroids...

Because they cause hypochloremia. Besides causing the hypokalemia, the steroids tend to cause hypochloremia.

Quote:
Originally Posted by indigo View Post
Point taken but even a steroid would do exactly the same and that's what i was trying to clarify
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Quote:
Originally Posted by indigo View Post
Point taken but even a steroid would do exactly the same and that's what i was trying to clarify
anabolic steriods are testosterone and dihydrotestoterone they r not glucocorticoids.
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Old 12-29-2011
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Help Got the answer...

But do not understand the normal Na and the hypochloremia...

https://www.facebook.com/NEET.PG.201...42566682455792
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Quote:
Originally Posted by step_enhancer View Post
anabolic steriods are testosterone and dihydrotestoterone they r not glucocorticoids.
Refer to Pg no 55 Kaplan behav sciences,Anabolic steroids decrease serum pottasium, I am assuming through increasing excretion in urine
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  #11  
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Unhappy So...

It can also be steroids... I do not get this answer.




Quote:
Originally Posted by indigo View Post
Refer to Pg no 55 Kaplan behav sciences,Anabolic steroids decrease serum pottasium, I am assuming through increasing excretion in urine
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Very good one . This might sound crazy, but i am guessing Anabolic steroids cause hypokalemia by increase the cell turnover, not by acting as week aldo, in which case the presence of excessive Potassium in the urine might point to diuretics. I might have just got to this from the answer .
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Warning!

Anyone notice:She presents with fatigue and weakness!!!. Using anabolic steroids will not result in weakness since its actions is ergogenic(energy producing) anabolic (muscle buildup), and androgenic(masculinizing). Using diuretics will cause fatigue because it disturbs the water nd electrolyte balance.
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  #14  
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Help But that...

...Is being caused by the underlying hypokalemia. The K levels that she has are the source of her muscular weakness. She even can develope myalgia, muscle cramps, flaccid paralysis and hyporeflexia with those levels.

Her weakness has nothing to do with the use or not of steroids...


Quote:
Originally Posted by patho2012 View Post
Anyone notice:She presents with fatigue and weakness!!!. Using anabolic steroids will not result in weakness since its actions is ergogenic(energy producing) anabolic (muscle buildup), and androgenic(masculinizing). Using diuretics will cause fatigue because it disturbs the water nd electrolyte balance.
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