Consequences of an extreme diet in the professional sport: Refeeding syndrome to a bodybuilder.

Refeeding syndrome, as a life-threatening condition, is well known among severely malnourished or deeply metabolically stressed patients. This case presents an atypical manifestation of the syndrome to a young bodybuilder, whose extreme diet, including 5 months of insufficient nourishment before the sport competition and 6 days of carbohydrates overload afterwards, has led him to a bilateral lower - limb paralysis and drastic homeostatic disturbances. Severe hypokalemia, hypophosphatemia, hypomagnesemia and hyperglycemia with mildly elevated liver enzymes have occurred. The patient could barely move his legs and arms, and his state has been followed by a hypertensive crisis, which required an immediate intravenous treatment. Although his weight was 112,5 kg with a body mass index of 32,2 kg per square meter, and his blood serum albumin concentration resulted inside the normal range, the overall condition was corresponding to the state of extenuated and malnourished patients. This case reflects to high prevalence of eating disorders or non-adequate nutrition among weight-sensitive sport athletes. The importance of prevention and opportune diagnostics of refeeding syndrome among special vulnerable groups should be considered.

A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre.

Tricholoma equestre (hereinafter - T. equestre) is a common edible fungus that is considered to be toxic under certain conditions. Here, we report four cases of acute poisoning caused by T. equestre, including one lethal outcome in Lithuania between 2004 and 2013. In the severe case, fatigue, nausea without vomiting and muscle pain, profuse sweating without fever, and respiratory insufficiency occurred. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Although clinical findings and laboratory tests support evidence of rhabdomyolysis, no renal insufficiency was observed. Significance of T. equestre in cardiac changes is feasible but remains unclear.