Understanding My Health Concerns: Possible Metabolic Alkalosis
I am a 34-year-old female experiencing persistent high levels of carbon dioxide (32 mmol/L). Over the past year, I've been suffering from a range of perplexing health issues including extreme fatigue, brain fog, tremors, migraines, and muscle twitches. My primary care physician seems puzzled by the elevated CO₂ levels, and I’m beginning to wonder whether this could be linked to mild ammonia accumulation or metabolic alkalosis. Several years back, I faced severe IBS-D coupled with malabsorption, leading to a deficiency in protein and a noticeable drop in creatinine levels (currently at 0.5), which might indicate muscle depletion. This year, I received a diagnosis for significant B12 and folate deficiencies that were not diet-related. I commenced treatment with methylcobalamin injections and oral folate supplements, and thankfully, my IBS-D symptoms improved after receiving therapy. However, my neurological issues escalated to an alarming degree: following my B12 and folate administration, I began experiencing tachycardia, muscle cramps, confusion, visual anomalies, and breathing difficulties. My potassium and magnesium levels remain within normal ranges (3.5 and 1.9, respectively). Notably, my last urine pH reading was 8, and both my sweat and urine occasionally emit an ammonia-like odor. It’s important to mention that I do not use diuretics, antacids, or calcium supplements, and I maintain good hydration. Both my liver and kidney function tests are normal, and I do not have a history of smoking or lung conditions. I’ve been contemplating whether this could be a refeeding syndrome, where the sudden introduction of B12 and folate heightens metabolic needs, while my amino acid levels (such as glutamine, glycine, and aspartate) are too low to manage the resultant waste, particularly ammonia. There’s a possibility that my urea cycle is not operating efficiently, causing my body to retain CO₂ as a compensatory response to alkalosis. I have some pressing inquiries: - Is my hypothesis logical? - Should I request an ammonia test along with an amino acid profile? - Which specialist would be best suited to help assess my condition? Or would my primary care physician be able to manage this? I hope I don’t come across as overly anxious, but it’s vital to me that my concerns are treated with seriousness when I visit my doctor next week. I appreciate your time and assistance, as it truly is valuable.
Answers (1)
7/30/2025, 1:31:06 AM
OpenHealth AI
It's understandable to feel concerned given your complex symptoms and health background. Your hypothesis regarding potential metabolic alkalosis and related issues seems well-considered, especially given your history with malabsorption and nutrient deficiencies. Here’s a structured response that addresses your questions:
Main Points
- Logical Hypothesis: Your consideration of metabolic alkalosis and ammonia accumulation appears reasonable, particularly with your high urine pH and symptoms post-B12 and folate administration.
- Testing Recommendations: Requesting an ammonia test and an amino acid profile may provide valuable insights into your metabolic state and help clarify your symptoms.
- Specialist Consultation: A referral to a specialist in either endocrinology, nephrology, or a metabolic disorder clinic might be beneficial.
Explanation
- Metabolic Alkalosis: This condition typically occurs when the body's pH level is elevated due to loss of acids or an increase in bicarbonate. High CO₂ levels could indicate your body is trying to compensate for this imbalance. Persistent symptoms like muscle cramps, tachycardia, and brain fog can sometimes relate to electrolyte imbalances or metabolic disturbances.
- Ammonia and Amino Acids: Elevated ammonia levels might suggest inefficiencies in your urea cycle, especially given your low creatinine, which can hint at potential muscle wasting or metabolic issues. An amino acid profile can help understand if you have deficiencies that might be exacerbating your symptoms.
Next Steps
- Request Specific Tests: At your next doctor’s appointment, ask for:
- An ammonia level test.
- An amino acid profile to check for possible deficiencies that could affect your symptoms.
- Bring Relevant Documentation: Prepare a concise summary of your symptoms, previous tests, and treatments to discuss with your doctor. This will help in communicating your concerns effectively.
- Consult a Specialist: If your primary care physician is unable to provide clarity or solutions, consider requesting a referral to:
- An endocrinologist for hormonal and metabolic assessments.
- A nephrologist to evaluate kidney function and ammonia processing.
- A specialist in metabolic disorders for a comprehensive evaluation of your symptoms.
Final Thoughts
Your concerns are valid, and it's important that you advocate for yourself during medical visits. Keeping a detailed log of your symptoms, dietary habits, and any triggers may also facilitate discussions with your healthcare provider. Remember, you're seeking answers, and it's okay to take proactive steps toward understanding your health better. You deserve thorough exploration of your concerns.
Related Questions
Comparing Laminoplasty and Laminectomy/Fusion for Cervical Spine Stenosis
Hello, I'm a 63-year-old woman, standing 5’6” and weighing 200 pounds. I take gabapentin to manage nerve pain associated with my condition. I don’t smoke or drink, and I don’t have any other medical issues. My medical history includes gallbladder removal two decades ago and a cesarean section thirty years past. I have been diagnosed with severe cervical stenosis. Two different surgeons have advised that I require surgery promptly to avoid the risk of further or permanent damage. A neurosurgeon has suggested a posterior laminectomy spanning C3-C6, along with a fusion of C3-C7. Conversely, an orthopedic spine specialist has proposed laminoplasty in the same region. I am eager to understand the rationale behind choosing a fusion procedure over a non-fusion approach, especially given the deterioration of my symptoms, which include persistent numbness and tingling in my hands, arms, feet, and legs, as well as issues with balance. I appreciate any insights you may have. Extensive testing has excluded diabetes, thyroid problems, carpal tunnel syndrome, and deficiencies in B12, B6, copper, and zinc as potential causes for my symptoms. **Cervical Spine MRI Results**: - **CERVICAL DISC LEVELS**: - **C2-C3**: No significant abnormalities in the discs or facets, and no spinal stenosis or foraminal narrowing noted. - **C3-C4**: Similar observations with no significant abnormalities. - **C4-C5**: Broad-based disc and uncovertebral joint hypertrophy are causing moderate spinal canal stenosis, yet the neural foramina are open. - **C5-C6**: Presence of uncovertebral facet joint hypertrophy leading to moderate right neural foraminal stenosis and severe spinal canal stenosis, with the left side remaining open. - **C6-C7**: Mild broad-based disc with uncovertebral facet joint hypertrophy causing mild bilateral neural foraminal stenosis and moderate spinal canal stenosis. - **C7-T1**: No significant abnormalities detected. - **CRANIOCERVICAL REGION**: Appears normal with no signs of Chiari malformation. - **PARASPINAL REGION**: Normal, with no masses observed. - **BONY STRUCTURES**: No evidence of fractures, defects, or lesions identified. - **CORD**: Shows normal size, contour, and signal intensity. **Conclusion**: The findings indicate multilevel degenerative changes with severe spinal canal stenosis being most pronounced at the C4-C5 level.
Experiencing Dizziness After Looking Left for an Extended Time — Is It Cause for Concern?
I am a 20-year-old female with a background of iron deficiency, sporadic heart palpitations, Benign Paroxysmal Positional Vertigo (BPPV), and vestibular migraines. At present, I am not taking any medications. Today, I held my gaze very far to the left to observe for nystagmus, which I noticed earlier; this condition seems to occur in both extreme left and right positions, but it is more noticeable when I look right. The nystagmus has a rotational movement and tends to point towards the direction I’m facing. Alongside this, I have had a sensation of blockage in my left ear for the past two days. While maintaining this extreme left gaze for a short while, I unexpectedly felt a momentary sway, quickly followed by a jarring episode of spinning vertigo that persisted for about 5 to 10 seconds. Fortunately, it resolved by itself and did not involve any other neurological signs, such as weakness, slurred speech, or numbness. Considering my medical history, I am curious: can maintaining a gaze in an extreme position potentially induce a stroke in the brainstem or cerebellum? Or is this more likely to be a transient response from the vestibular system, indicating a short-lived dysfunction in either the peripheral or central aspects? I appreciate any insights you may have!
Am I Overreacting?
Greetings, I’m a 23-year-old male, weighing 160 pounds and standing at 6 feet tall. About a week ago, I engaged in unprotected oral and anal intercourse. Since that time, I’ve noticed some slight swelling in the lymph nodes located in my neck. Additionally, I have a persistent feeling of mucus in my throat, though there are no visible patches or obstructions. It feels as if something is lodged there continuously. Regarding my anal region, there has been some itchiness. However, I’m unsure if this is something more than what I typically experience. I have been dealing with constipation, and the itch tends to flare up either after I use the restroom or if I scratch the area. Could it be that I am simply being overly anxious, or is there a possibility that these symptoms might indicate a sexually transmitted infection? I’ve received suggestions that my symptoms could be attributed to post-nasal drip and irritation from wiping. I’ve also been advised to wait a week to monitor if there are any changes in my condition, yet I felt inclined to seek some additional insight here.
Unusual Forehead Sensation
I'm feeling quite anxious and could really use some assistance. At 19 years old and female, I've been experiencing a peculiar sensation in my forehead. Specifically, when I touch the upper left part of my forehead, I encounter an odd electric shock-like feeling that is unique and difficult to articulate. Sometimes, this sensation also extends to the back of my head, and when I feel it there, it occurs simultaneously with the sensation in my forehead. I'm overwhelmed with worry, as I can't shake the fear that it might be a brain tumor. It's distressing because I’m unsure of the next steps to take. My mother reassured me that if I can feel it upon touching, it likely isn’t related to my brain, so it shouldn't be a tumor. Nonetheless, I am seeking advice because I am struggling to move past these thoughts. This has been ongoing for about a month now.
Understanding Multinodular Goiter: Is There Cause for Alarm?
Greetings, everyone. I'm a 23-year-old male experiencing a mild sore throat that has lasted about three days. I recently had an ultrasound of my thyroid, which revealed multiple nodules on both sides. The largest measures 1.51 × 1.18 cm on the left side, while a smaller one on the right side measures 0.66 × 0.33 cm. These nodules have been characterized as well-defined colloid nodules, with no signs of calcification or suspicious blood flow. The elastography results indicated a strain ratio below 4.8, leading the radiologist to classify these findings as TI-RADS II, suggesting benign characteristics. My thyroid-stimulating hormone (TSH) and thyroxine (T4) levels are both within normal ranges, and I exhibit no signs of either hyperthyroidism or hypothyroidism. The report also noted a few small cervical lymph nodes, which appeared reactive, likely due to my sore throat. I am currently on an SSRI medication, and I’d like to know: - What could possibly lead to the development of these benign nodules? - Should I have any concerns regarding a potential cancer risk in the future? - Has anyone experienced similar thyroid ultrasound results, and did your nodules remain stable or continue to grow? I am eager to grasp the broader context surrounding my condition and would appreciate any insights you can share.