Anyone Else Ever Have Wonky Labs Like This (Abnormal Blood Gases)?

[ks42]

Last night I went to the ER because I'd been experiencing left sided chest pressure with a nasty cough for about two weeks, and it suddenly got worse (along with some new chest pain). Along with this, my POTS decided to flare completely out of control, and every little move I made (even sitting up in bed) would send my heart rate up past 130, which is really not typical for me anymore. Adrenaline surges every few seconds too!

EKG and chest x-ray were OK, but the weird thing was that my labs came back with low CO2 and high anion gap, indicating some sort of acidosis. I also had ketones in my urine (highly unusual for someone who's not diabetic or starving themselves!!). My blood sugar and the rest of my electrolytes were fine. The ER doc chalked everything up to typical POTSy dehydration, gave me fluids, and discharged me. The chest pressure, chest pain, & cough are still there, so I'm following up with my PCP today (and probably cardiology too).

Is there anyone else who knows if they've ever had acidosis or abnormal blood gas levels (CO2, anion gap, etc)? I'm discussing this with my regular doc today, I was just curious if it really does happen sometimes when us POTsies get dehydrated.

Also, has anyone ever had chest pressure that lasts for an extended amount of time? I've had it before, but only very intermittently; it's never stayed constant this long. It's driving me crazy. Right now, it feels like my 40 pound puppy is sitting on my chest (which has happened before, so I actually have a frame of reference, haha).

[Katybug]

I've had low CO2 and elevated anion gap once in my blood work but it was never like that again so it wasn't investigated.

From your signature, I doesn't look like you're on this type of med, but I'll mention this anyway. When I was put on Topamax as a migraine preventative, I developed chest pressure, increased chest pain, a cough, and if I tried to talk I could only get out one sentence before I would start choking and coughing. It was scary for me and for my friends and family. I looked like death and losing the ability to talk in any meaningful way was very disconcerting. I do have mcas but I don't know if it was an mcas reaction to the med or just a general reaction to it. Can you trace this set of symptoms, or the worsening of the symptoms, to starting or increasing the dosage on any meds or supplements?

[ks42]

Interesting. Thanks for that suggestion, I haven't taken any new meds or anything, but I do have a few supplements that I kind of tend to take on a very irregular basis. I might stop all supplements for a little bit and see, since none are essential. Maybe I'm even starting to react to something I'm eating, or something in my environment. I'll try to think back to any changes like that when it started. Also, we think we have ruled out mast cell, but I know it's a really hard diagnosis, so I'm thinking we can't be 100% sure. When I talk to my POTS neuro next week I might ask about revisiting the mast cell idea.

For now, my primary care doc re-ran the labs - hopefully they're normal, so we won't have to investigate any further. She also said it's possible I just wound up with a bronchial infection, so she gave me an antibiotic (azithromycin) and said it's my call if I want to take it or not. I'm currently trying to decide if I want to go that route, as I tend to react to SO many meds.

[SarahA33]

Hi ks, This has been happening to me for the last year on and off. (3 or 4 times) My hematologist and pots doc's are aware of it. Co2, anion gap and chloride are slightly elevated. Was your creatinine normal? Mine always has been which means my kidneys are functioning okay at that time. Also, what about your glucose? Mine was borderline low once or twice? I am on Trokendi XR (extended release Topamax) but they were elevated before this. I blame the low glucose on the Topamax because it has caused such suppressed appetite, unless I remind myself I'm almost never hungry.

I also have had the same thought re: dehydration. I'm guessing the ER ran the labs before they gave you the fluids. Would have been interesting to do a before and after!

Hopefully this next set of labs that your primary ordered will come out okay! Sorry to hear that you were in the ER :-( I hope that you are feeling better.

Sarah

[ks42]

Sarah - yep, they did the labs before giving fluids. It will be interesting to see if the next set of labs is normal (fingers crossed). My creatinine and glucose were normal, fortunately!

Interesting that it's happened to you too. I do wonder if it's a dehydration or low blood volume thing.

And thanks - I do feel MUCH, much better.

[Debbie Rose]

So KS, How did things go with your new labs? My Anion Gap and Chloride was off by a smidge but my PCP said it was nothing to worry about.

I have been hypoglycemic most of my life and now am borderline (PRE) diabetic before these POTS symptoms showed up. And still get hypoglycemic easily. And now that I am on Florinef and latuda I have to be aware of my glucose, potassium, BP, weight and cholesterol=oh joy! I have a glucometer to check my glucose and though I have gained weight, everything was normal on Sept 16th

Just wanted an update to see what they found. Hope it went well.

Debbie

[ks42]

Debbie Rose - thanks for asking! The repeat labs were completely normal So far, all they can attribute it to is dehydration. We're going to start regular IV fluids (instead of just on an emergency basis) and if I have any more abnormal labs, in spite of the fluids, we're going to have to investigate further (hopefully not!).

[Debbie Rose]

Sounds great KS, glad things are back to normal-lab wize-LOL

Debbie