Hyperglycemic Hyperosmolar State Complicated by Acute Kidney Injury and Severe Rhabdomyolysis in a Bodybuilder with Newly Diagnosed Type 2 Diabetes: A Case Report

Abstract

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening complication of type 2 diabetes mellitus, typically affecting older adults. Bodybuilders represent a unique high-risk population due to high-protein diets, anabolic steroid use, intense exercise, and frequent use of supplements. Acute kidney injury (AKI) and rhabdomyolysis are underrecognized complications of HHS that are exacerbated by these bodybuilding practices.

Case Presentation: A 28-year-old male competitive bodybuilder with no prior history of diabetes presented with a 4-day history of extreme thirst, inability to train, dark urine, and progressive confusion. On admission, the bodybuilder was lethargic (Glasgow Coma Scale 11), severely dehydrated, with blood glucose 1,240 mg/dL, serum osmolality 385 mOsm/kg, creatinine 6.8 mg/dL (estimated baseline 1.3 mg/dL for a muscular male on creatine, representing a 5.2-fold increase), blood urea nitrogen 145 mg/dL, potassium 7.1 mEq/L, creatine kinase 68,000 U/L, and urine dipstick positive for blood without red blood cells. The bodybuilder was reported to have used anabolic steroids (testosterone enanthate, trenbolone) for 18 months, high-protein supplements (250 g protein daily), and high-dose creatine supplementation. Diagnoses included: (i) Hyperglycemic hyperosmolar state, (ii) Acute kidney injury (KDIGO Stage 3), (iii) Severe rhabdomyolysis, (iv) Newly diagnosed type 2 diabetes (HbA1c 10.8%). Nursing management was organized using Orem’s three nursing systems. The patient required 14 days of hospitalization, including 6 days in intensive care and three hemodialysis sessions. Renal function improved to near baseline (creatinine 1.6 mg/dL at discharge), and the bodybuilder was discharged on insulin therapy with structured education addressing bodybuilding-specific risks.

Conclusion: Bodybuilders with undiagnosed diabetes are at extreme risk for HHS complicated by AKI and rhabdomyolysis due to synergistic effects of hyperglycemia, anabolic steroids, high-protein intake, and intense exercise. Orem’s theory guides nursing interventions across the continuum from critical care to discharge education, emphasizing self-care capacity building for lifelong diabetes management while addressing bodybuilding culture.