Monday, April 11, 2016

Metabolic acidosis is next up - what next?

The shots keep comin

From the time of discharge life has sucked - first it was because my head was still killing me when they sent me packing after they increased my Diamox dose. However, that action was very short sighted as my head started to hurt less and I started to experience more and more nausea, dizziness and fatigue.

NOW - here's the kicker..... with ideopathic intracranial HTN (IIH), those symptoms can be symptoms of increased pressure and therefore I just need to be patient that the increased dose that we started me on will eventually work at managing that. OR those symptoms could be a dangeous set of symptoms called metabolic acidosis where the medication causes ingestion poisioning (sorta) and increases the acidity of the body - thowing off the pH of the body. As I've said before, with Diamox, I sit slightly acidotic but my body is able to compensate by increasing HCO3 (sodium bicarbonate) and my body also increases my respiratory rate to utilize my respiratory system to help compensate for what Diamox is trying to do.

So I waited a little bit to see if things would settle down - they didn't and so I went and saw my physician on Monday - had bloodwork drawn on Wednesday and then saw him again on Friday for the results. When I saw him on Friday the ONLY result that was sent was the useless pregnancy test that my physician threw in just for good measure! UGH - and because the lab was closed for the weekend, we would have to wait the weekend to know what the results from wednesday were.

So I went home from the appt rather irritated. I knew that something was wrong - I had the feeling that I was going acidotic and that something needed to be done. I took things upon myself and skipped doses of my diamox here and there to try to manage how severe the acidosis was. I just had an inkling - my lovely nursing senses were just a tingling let me tell ya!

Once home I had dinner then went for a nap. When I woke up I figured that I would try to get some school work done. Things are starting to become due and I can't just procrastinate just because I'm feeling terrible. I was sitting in front of the computer and watching a show and my chest started to hurt with a shocking pressure and charley-horse pain in my left arm from my shoulder to my elbow and I had interscapular pain - I tried not to think about it. I worry about whether I'm actually feeling this or whether it's all in my head. I know that when metabolic acidosis gets really bad that it can affect the heart so it's completely possible. Man did I hurt!

I waited about an hour of feeling like crap - with the dizziness, nausea, diaphoresis to go along with it - that I couldn't take it anymore. Off I went to the hospital. The initial ECG showed tachycardia but other than that it was normal. I also told them that it felt like I was losing beats. The ECG didn't pick it up but it's only a 10-15sec picture so big woop! But of course they don't put me on the monitor (which they really should have - stupid ppl) - considering when I got there my BP was 164/102!

I waited another 5 hours until I actually saw the Dr and when I did she was prepared at least - I didn't have to tell her my back story. She asks what brings me in - I told her about the metabolic acidosis thought and that I seriously needed a venous blood gas. She agreed! I got that then waited. I waited about 2.5 hours to find out that indeed I was suffering from it - though no results were given to me, nor was there any treatment. I was only told that my pH was 7.3 - but that she was concerned that that may continue to drop as my body tries to get through this.

When I was discharged with the blood work results & I was only told to reduce the amount that I was taking daily and to follow up in the hospital clinic during the week (though it doesn't open until monday and I wouldn't know when my appt time would be until monday when they would be the one to call me) but I also went to my family Dr and brought the bloodwork results to show him that I had developed moderate metabolic acidosis and that we needed to come up with a plan. Oh, and the blood work also showed that I had hypernatremia and hyperchloremia - which should have been dealt with considering I am taking diamox - a diuretic! Geeze ppl, way to drop the ball!!! So I told my Dr about what I had been doing to take care of matters myself.... making sure that I drink way more water (no juice or anything else - my K+ = 4.0 so it was ok to go ahead with this) and to skip more doses of the Diamox - but I had to be careful with this because I didn't want to put myself back in crisis mode trying to play catch up...... what a tricky thing I'm trying to accomplish!

So tomorrow is the day that will show everything. I have the requisition for bloodwork to take to my local hospital to have it drawn - unless I hear back from MY hospital of when they want me to see the Dr in the clinic - this would also include blood work. Tomorrow will tell me - I was told that I should hear something by noon. I still feel rather yucky but I feel better than I did. At least I don't feel like I'm having cariac issues anymore - when I got home I was still having the pain - so I had to self medicate with some morphine and zofran - thankfully after that and a nap I was feeling the cardiac pain was sooooo much better.

I had to let my profs know that's been going on with me as well - thankfully both of them have been great and have given me extensions. I just can't believe how I keep getting sick at the same point in time each semester. Now I just need to get better and STAY better!!!!!!! Wow though, these hits just keep coming! Just know that metabolic acidosis is rare - and it's amusing that IIH is a rare condition and then I get the rare of the rare things happen...... go figure!!!!

1 comment:

  1. Goodness gracious! I'm so glad you were able to self-diagnose and know how to treat and when to go in. I'm so glad you're a nurse and know what's going on and can advocate for yourself! I cannot imagine what happens for people who don't know anything about medicine and health when they are in similar situations. I pray you begin to feel better and I'm grateful your professors are helping you a bit.