Abstract Introduction The belief that “natural” products are “safe” is a critical public health myth. Many herbal and dietary supplements, increasingly used for cognitive and physical enhancement, contain biologically active compounds that can alter physiological systems, leading to adverse effects from direct toxicity, exaggerated pharmacological action, or interactions. The performance enhancer Creatine and Dandelion root both carry a risk of promoting dehydration, muscle cramping, and potassium loss (hypokalemia). When used together, these agents can synergistically precipitate severe metabolic disturbances. We present a case of acute weakness and paralysis secondary to a profound electrolyte imbalance induced by the concurrent use of Creatine and herbal supplements. Case Description A 20-year-old healthy male presented to the emergency department with a one-day history of gastrointestinal distress, palpitations, generalized weakness, and paralysis of the lower extremities. He reported taking several supplements (Creatine, nacroot, lion’s mane, and dandelion root) for the past 20 days to boost energy levels. On examination, he was tachycardic with dry mucous membranes and decreased lower extremity strength. Laboratory analysis revealed profound electrolyte disturbances: hypokalemia (1.2 mmol/L), hypomagnesemia (1.5 mg/dL), and hypophosphatemia (0.4 mg/dL). Thyroid studies were notable for suppressed thyroid-stimulating hormone (TSH) levels (0.01 μIU/mL), elevated total thyroxine (T4) levels (17.6 μg/dL), free T4 levels (5.1 ng/dL), and triiodothyronine (T3) levels (312 ng/dL), consistent with hyperthyroidism. Electrocardiogram revealed sinus tachycardia with peaked T waves, and elevated troponin levels (initially 295.5 ng/L, peaking at 9,488.3 ng/L), consistent with non-ST elevation myocardial infarction (NSTEMI). Chest X-ray and urinalysis were unremarkable. He was admitted to the Intensive Care Unit (ICU) for further management. During his ICU course, electrolytes were aggressively repleted, and methimazole was initiated for hyperthyroidism. Echocardiogram revealed a normal ejection fraction without structural abnormalities. Following electrolyte normalization, his muscle strength fully recovered, and he was discharged. Discussion This case underscores the potential dangers of combining unregulated supplements with overlapping metabolic effects. Acute paralysis and cardiac injury were precipitated by severe electrolyte depletion, which resulted from the synergistic effects of dandelion root’s diuretic action and Creatine’s metabolic demands. The resulting hypokalemia and hypomagnesemia likely precipitated the muscle weakness, paralysis, and cardiac injury. Furthermore, the patient’s concurrent hyperthyroid state amplified metabolic and cardiac workload, exacerbating myocardial stress. This complex interplay between herbal supplements and endocrine dysregulation illustrates how “natural” products can trigger life-threatening complications. Heightened public and clinical awareness, along with patient education on the dangers of unsupervised supplement use, remains a crucial preventive measure. This abstract is funded by: None
Okubadejo et al. (Fri,) studied this question.