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මේකට මොකක්ද කරන්න පුලුවන්? (medical issue)
- Thread starter Fiona Dabare
- Start date
umba endocrinologist langata yanawa nam leddu adu ekek hoyan palayan.. prasidda leddu lot inna un langata yanna epa, un umba kiyana katha ahan innewath naha wadiya..
d3, b12, zinc, iron ehema test kara ganin mokada samaharu anxiety seen eke extreme yanawa owa deficient unama..
ඒ මොකද්ද බන් එහෙ ලස්සන කෑලි ඉන්නවද?නැත්තන් උඹ පව් පොඩි එකෝඅවුලක් නැ, ගියත් යන්නේ පරනිම්මිත වසවර්තියේ තමයි.
ඔක්කොම note එකක් දා ගත්තා එයාට දෙනවා බලන්න කියලා.
දිවයලෝකයක්ලු, කෑලි ඉන්නවද කියල දන්නැ ඒවා ගැන වැඩිදුර දැනුම ලබාගන්න වෙන්නේ @ek_rosh @mastech වගේ අයගෙන්.
මගේ කලින්,
Sodium - 136.2 (Normal Range 136-145)
Potassium - 3.2 (Normal Range 3.5-5.3) තිබ්බේ first episode එක වෙලා hospital admit කරද්දි.
BP 151/88 (seated),138/85 (supine)
අනිත් ඔක්කොම bloodwork normal.
zincovit දුන්නා මාසයක් ගන්න, ඒ නිසා nutrients deficiency එකක් වෙන්න බැහැ.
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බොට තියෙන්නෙ සාංකාව බන්. වෙන මොන ලබ්බක්වත් නෙමෙයි. ආදරය කරන්න කෙල්ලෙක් නැත්තන් අඩුම තරමෙ බව්වෙක් පූවෙක්වත් ගෙදරට ගෙනෙන්. අපි මනුස්ස සත්වයො බන්. කිස් කළාම කොච්චර ඇඟේ වෙනසක් වෙනවද දන්නවනෙහ් බෝ. කුක්කු දැක්කම පිරිමි විදියට අපි දිව්යලෝකෙ ඉන්නෙ කියල උඹ දන්නවනෙ. ඕව මනුස්ස වුවමනා එපාකම්. එක්කෝ හොඳ කෙල්ලෙක් හොයාගනින් බන්
nikan oya brain tumor case eka passe yanna epa mokada naturally godak unge owa thiyanawa, and 99% ewa benign..
habai oya path eke giyama owala biopsy karannai puka dennai huge risk, side effects and kathandara godai...
doca wa unath umba nikarune oya path ekata harewwamma uth ehema possibilities balanna gannawa.. uta nemei umbatai risk eka..
එම biopsy කරන්නැ එකපාර. hormones වැඩිනම් ඒකෙන් indicate වෙනවා අදාල අවයවයේ tumor එකක් කියලා. ඊට පස්සේ imagine tests, bloodwork, bio markers වලින් rule out කරන්න පුලුවන් benign tumor එකක්ද නැද්ද කියලා (බොහෝ දුරට). benign tumor එකක්නම් shrink වෙන්න බෙහෙත් දෙනවා හෝ නිකන් තියෙන්න දීලා monitor කරනවා. surgically remove කරන්න වෙන්නේ මොලේට බලපෑමක් වෙනවනම් විතරයි. නැතුව biopsy එකක් වෙනුවෙන් open brain surgery එකක් කරන්නැහැ pituitary gland එකේ.
අනික මගේ TSH normal. ACTH විතරයි බලන්න ඕනේ. Prolactin or අනිත් hormones වලට එන symptoms මට නැ.
ACTH වලිනුත් cortisol වැඩි වෙන නිසා, cortisol 24 hr normal නම් ඒත් අවුලක් නැ. morning cortisol එකක් කලින් කරා මන් ඒක normal but not enough to rule out this matter.
malignant tumor එකක් මාස 7 තිබ්බනම් මෙලහට severe symptoms එන්න ඕනේ...seizures, neurological symptoms, vision problems.. මට ඔලුවේ කැක්කුමක් වත් නැ.
මට සුවර් නැත්තේ adrenal gland එක.
මුසාවාදා නෙමෙයි.
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උඹේ කෙල්ලව දැන්මම හොඳ කොල්ලෙක්ට දීපන්. උඹේ කාලෙ ඉවර වේගෙන එන්නෙ මලේ
tremors
tachycardia
fatigue
stomach pain/ bloated stomach
feeling physically off
excessive thirst
dry skin, lips
muscle pain/ sore muscles
heightened auditory perceptions
tests අවුලක් නැති වුනාට, ඒ කරපු tests ටික මදි හරියට මේක endocrine issue එකක් නෙමෙයි කියලා rule out කරන්න.
Possible conditions that can tie these symptoms together (from most to least common)
Practical next steps
Key takeaway
A relatively common, benign cause such as dehydration with electrolyte loss or excess stimulants/anxiety can produce the exact cluster you describe, but more serious disorders (thyroid overactivity, early diabetic crisis, medication toxicity) can present similarly. Basic bedside measurements and routine lab tests quickly differentiate them, so getting checked soon—especially if symptoms persist beyond 24 h or worsen—is the safest course.
- Dehydration ± electrolyte imbalance
• Loss of body water (from sweating, inadequate intake, diarrhea, vomiting, diuretics, heavy caffeine/energy-drink use, or high heat) can produce:
– Tremors or muscle cramps/aches (low potassium, magnesium, or calcium)
– Tachycardia and palpitations (heart compensates for low circulating volume)
– Fatigue, feeling “off,” dizziness
– Dry lips/skin, excessive thirst, bloating or vague stomach discomfort
– Sensory “hyper-awareness” (adrenal surge from physiologic stress)
- Excess sympathetic stimulation (anxiety/panic attacks, excess caffeine, some decongestants, stimulants, thyroid hormone)
• Catecholamine surge → tremor, rapid heart rate, heightened senses, dry mouth/skin, gastrointestinal “butterflies,” sore/tense muscles, fatigue after the surge subsides.
• Clues: temporal relationship to stress, caffeine, or medication; episodes come in waves.
- Hyperthyroidism (overactive thyroid or medication overdose)
• Classic triad: fine tremor, tachycardia, heat intolerance/fatigue.
• May also cause muscle weakness/soreness, anxiety‐like sensory amplification, diarrhea or abdominal pain, weight loss (sometimes masked by bloating).
• Skin can become thin and dry; thirst rises from increased body heat.
• Simple blood tests (TSH, free T4/T3) confirm or exclude.
- Early or mild hyperglycemia / diabetic ketoacidosis (DKA) spectrum
• Excessive thirst, dry mouth/skin, fatigue, abdominal pain, tachycardia.
• Tremors and muscle pain appear when electrolytes shift (potassium loss).
• A quick capillary glucose check or urinalysis for ketones rules this out quickly—act urgently if sugars are ≥250 mg/dL, breathing is deep/rapid, or nausea/vomiting develop.
- Medication or substance side-effects
• SSRIs/SNRIs (serotonin syndrome spectrum), bronchodilators, lithium, theophylline, withdrawal from alcohol/benzodiazepines, recreational stimulants: all can combine tremor, tachycardia, GI upset, thirst/dryness, myalgia, sensory changes.
• Review any recent medication or dosage change.
- Adrenal issues (adrenal insufficiency or pheochromocytoma)
• Less common, but both can give tachycardia, tremor, GI discomfort, muscle aches, fatigue.
• Adrenal insufficiency often adds low blood pressure, salt craving, skin darkening; pheochromocytoma produces severe episodic spikes of heart rate and blood pressure plus drenching sweats.
- Systemic infection or sepsis in early phase
• “I feel off,” mild abdominal pain/bloating, fast heart rate, tremor/shivering, thirst/dry lips from fever-related fluid loss.
• Fever may still be low-grade or absent at first.
Practical next steps
- Immediate self-checks
• Measure temperature, resting heart rate, and (if available) blood pressure and finger-stick glucose.
• Drink 500–1000 mL of an oral rehydration solution or sports drink and see if tremor or heart rate improve in 30–60 min.
• List any caffeine/energy drinks, medications, or supplements taken in the last 24 h.
- Seek urgent care (same day) if you notice:
• Heart rate >120 bpm at rest that stays elevated
• Blood glucose >250 mg/dL or large urine ketones
• Fever >38.5 °C, persistent vomiting, severe abdominal pain, chest pain, confusion, or fainting.
- Schedule a prompt physician visit to run:
• Basic metabolic panel (electrolytes, kidney function)
• Serum glucose ± HbA1c
• Thyroid panel (TSH, free T4)
• Complete medication/substance review
- While waiting for evaluation
• Hydrate regularly with water + electrolytes.
• Reduce caffeine/stimulant intake to zero.
• Rest, use gentle stretching to ease muscle soreness, and track symptom onset, duration, and triggers in a diary.
Key takeaway
A relatively common, benign cause such as dehydration with electrolyte loss or excess stimulants/anxiety can produce the exact cluster you describe, but more serious disorders (thyroid overactivity, early diabetic crisis, medication toxicity) can present similarly. Basic bedside measurements and routine lab tests quickly differentiate them, so getting checked soon—especially if symptoms persist beyond 24 h or worsen—is the safest course.
මේක රූල් අවුට් කර ගන්න තමයි ඕනේ.
SNRI බොන ගමන් metanephrine test එක කරන්න බැහැ. SNRI cold turkey නවත්තන්නත් බැහැ.. ඒකයි ප්රස්නේ මේකට මොකක්ද කරන්නේ කියන එක
Key challenge:
SNRIs (e.g., venlafaxine, duloxetine, desvenlafaxine, milnacipran, levomilnacipran) increase synaptic norepinephrine and can raise circulating catecholamines and metanephrines, the very analytes used to screen for pheochromocytoma. This produces frequent false-positive biochemical tests. The goal is to obtain at least one reliable set of results uncontaminated by the drug.
- Temporarily withdraw or switch the SNRI
• If the psychiatric risk is low to moderate, taper off the SNRI for ≥2 weeks (≈5 half-lives) before drawing blood or collecting 24-h urine.
– Venlafaxine & desvenlafaxine: 5–7 days minimum; 14 days preferred.
– Duloxetine: 7–10 days minimum; 14 days preferred.
• Manage withdrawal with a short taper (reduce dose every 2–3 days) and start an SSRI (sertraline, escitalopram, fluoxetine) or buspirone if an antidepressant is still needed; these do not interfere with catecholamine testing.
• If stopping the SNRI is unsafe (high suicide risk, refractory depression):
- Obtain psychiatric clearance for a closely supervised taper that lasts as short as clinically feasible, or
- Proceed to alternate biochemical or functional tests (see below).
- Choose the least drug-sensitive biochemical test
• First-line after drug washout: Plasma free metanephrines measured after the patient rests supine for 20–30 min in a quiet room. (Superior sensitivity; modest increase from SNRIs resolves after washout.)
• If the SNRI cannot be stopped:
– 24-h urinary fractionated metanephrines tend to be less affected than plasma catecholamines but still show some false positives.
– Chromogranin A is unaffected by SNRIs but has lower specificity; use only as adjunct.
– Urinary 3-methoxytyramine (3-MT) is not influenced by SNRIs and can help rule out head-and-neck paragangliomas, although data are limited.
- Consider a functional suppression test (second line)
• Clonidine suppression test (for borderline‐elevated plasma catecholamines):
– Give oral clonidine 0.3 mg after baseline catecholamine draw.
– Measure plasma catecholamines again at 3 h.
– In true pheochromocytoma, norepinephrine stays elevated; in drug-induced elevation it suppresses by ≥40 % or to <500 pg/mL.
– Ensure normal blood pressure and cardiac status before using clonidine.
- Imaging only after unambiguous biochemical confirmation
• CT/MRI adrenal or extra-adrenal, and ¹²³I-MIBG or ⁶⁸Ga-DOTATATE PET, should be performed only when biochemical evidence persists after drug washout or alternate testing confirms excess catecholamine production.
- Practical workflow summary
- Psychiatric review → plan SNRI taper (aim ≥2 weeks off).
- During washout: monitor for discontinuation syndrome; cover with SSRI if needed.
- After washout: draw plasma free metanephrines with proper supine rest.
- If still positive or SNRI cannot be stopped:
• Repeat test with urinary metanephrines ± 3-MT
• Add clonidine suppression test.
- Proceed to imaging only if biochemical tests remain positive.
Take-home point:
Because SNRIs reliably elevate catecholamine measurements, the simplest and most reliable way to rule out pheochromocytoma is to stop the SNRI long enough for it to clear, then repeat high-sensitivity plasma free metanephrines under standardized conditions. When withdrawal is impossible, combine the least drug-sensitive analytes with a functional suppression test to reach a confident conclusion.
මේ tests දෙක නැ Asiri labs list එකේ
CT unnecessary radiation risk එකක්. මගේ anxious මොලේ සනසන්න ගිහින් අන්තිමට ඇත්තටම ලෙඩක් හදාගන්න වෙන්නේ.
MRI referrals කොහොමත් දෙන්නැහැ excessive sweating, headache, high BP නැති නිසා.
මේක තමයි ඉතින් කරන්න වෙන්නේ..
මේ ගොඩක් ඒවා Anxiety or stress response වෙන්නත් පුළුවන් නේද. endocrine disorders නම් diabetes or thyroid disfunction තියනවනෙ. මෙහෙ ලෙඩ හොයා ගන්න එක නම් ලේසි නෑ.
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