Faustino Ranken
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Dianabol
Dianabol (Methandrostenolone) – A Comprehensive Overview
Introduction
Dianabol, chemically known as methandrostenolone or methandienone, is a first‑generation anabolic–androgenic steroid (AAS) that was originally developed in the 1950s for medical use (e.g., treating muscle wasting disorders). Over time it gained popularity among bodybuilders and athletes due to its rapid strength gains and lean muscle mass increases.
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1. Pharmacology & Mechanism of Action
Feature Details
Class Oral anabolic steroid
Molecular Formula C₁₇H₂₃NO₂
Mechanism Binds to androgen receptors in muscle cells, enhancing protein synthesis and nitrogen retention. It also increases erythropoiesis (red blood cell production) via stimulation of the kidneys’ erythropoietin production.
Protein Synthesis: Accelerates transcription of genes responsible for muscle growth.
Nitrogen Retention: Increases net protein balance by decreasing proteolysis.
2. Primary Therapeutic Uses
Use Target Patient Population Dosage Regimen (Common)
Muscle wasting disorders (e.g., cancer cachexia, HIV-related wasting) Adults with significant weight loss or muscle atrophy 50–200 mg daily; adjust based on body mass and clinical response.
Chronic kidney disease (CKD) CKD patients experiencing protein-energy malnutrition 25–75 mg/day depending on severity; monitor renal function.
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3. Mechanism of Action
Protein synthesis stimulation: Enhances translation initiation factors, leading to increased amino acid incorporation into muscle proteins.
Anti-catabolic effect: Reduces ubiquitin-proteasome pathway activity, limiting breakdown of muscle fibers.
Improved nitrogen balance: Leads to positive nitrogen retention and subsequent lean mass accrual.
4. Dosage Recommendations
Condition Typical Starting Dose Maximum Recommended Dose Frequency
Muscle wasting due to chronic disease 10–15 mg/kg/day (split into 2 doses) 30 mg/kg/day total Twice daily
Cachexia in cancer patients 5–10 mg/kg/day 20 mg/kg/day Once or twice daily
Post‑operative muscle recovery 10 mg/kg/day 25 mg/kg/day Twice daily
Adjust based on patient weight, renal function, and tolerance.
Monitor for signs of excess protein intake: edema, hypertension.
5. Monitoring and Adjustments
Parameter Frequency Target / Action
Body weight & BMI Weekly ≥0.5 kg/week gain; if <0.2 kg/week, increase calories by 250 kcal/day
Muscle mass (DXA/CT) Every 4–6 weeks ≥1% increase in lean mass; if plateau, increase protein by +3 g/d
Serum albumin & pre‑albumin Monthly <3.5 g/dL → review nutrition plan
Blood pressure Weekly If >140/90 mmHg, adjust salt intake (≤2 g/day) and consider antihypertensives
Glycemic control (HbA1c) Every 3 months If >7%, adjust carbohydrate distribution
Monitoring Schedule
Day‑by‑day: Intake records, weight, BP.
Weekly: Weight trend, dietary compliance check.
Monthly: Lab values, albumin, pre‑albumin, HbA1c if diabetic.
Quarterly: Re‑assessment of nutritional status, dietary adjustments.
6. Rationale & Evidence
Intervention Reasoning Key Studies / Guidelines
Target 30 kcal/kg and 1.2–1.5 g protein/kg Adequate energy and protein prevent muscle loss; recommended for hospitalized older adults with chronic illness (ASPEN/ESPEN guidelines). ASPEN Clinical Practice Guideline on Nutrition Support Therapy (2020); ESPEN guideline on clinical nutrition in geriatrics (2018).
Oral supplements or enteral feeding when oral intake <50 % of goal Supplemental feeds increase nutrient density without compromising autonomy; evidence shows improved nitrogen balance and functional outcomes. RCTs on oral nutritional supplementation in hospitalized older adults; meta‑analysis by Vellas et al., 2019.
Sodium restriction (≤2 g/day) for hypertension Dietary sodium reduction lowers blood pressure, improves cardiovascular risk profile; aligns with AHA/ACC guidelines. AHA/ACC Hypertension Guideline 2017; DASH diet evidence.
Regular monitoring of weight, BP, labs Prevents rapid deterioration and detects complications early (e.g., hyper/hypoglycemia). Clinical practice guidelines for geriatric nutrition monitoring.
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5. Implementation & Follow‑Up
Day 0 – Initiate the nutritional plan; start sodium restriction.
Daily – Record weight, BP, appetite; provide oral supplement as needed.
Week 1–4 – Reassess weight, labs, BP; adjust calories/protein accordingly.
Month 2–3 – Evaluate functional status (e.g., hand grip, gait speed); consider adding resistance training if feasible.
Ongoing – Continue monitoring until stable or until transition to a long‑term care facility where dietitian guidance can be continued.
Bottom Line
The patient is in a critical phase of weight loss and malnutrition that threatens her survival. A structured, high‑calorie/high‑protein plan with close monitoring is essential to reverse the decline and improve outcomes. The approach should balance aggressive nutritional support with practical feasibility within the nursing home setting.