Discussions By Condition: I cannot get a diagnosis.

What's going on?

Posted In: I cannot get a diagnosis. 9 Replies
  • Posted By: kodger99
  • January 7, 2009
  • 00:17 AM

Unexplained weakness, fatiguability with little exertion. Morning, first thing out of bed is the worst! Feel weak and have the least amount of endurance out of the whole day.
Climbing 2 flights of stairs will burn me right out. It's like my large muscles loose all power. Just moving after this simple exertion is impossible until I sit for a while. Achy back later in the day too. Have got low blood phosphates and my doctor has no idea. A four month wait to see a neuphrologist. Is this the right direction?
Does anyone have ideas?

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  • There are a number of causes for hypophosphatemia. Your list of symptoms would indeed suggest the presence of such a disorder and although I intend no disrespect here, I'll be rather direct in simply asking whether you have recently been suffering from excessive alcohol intake or deliberate withdrawl? One of the most common causes in low serum phosphate is caused when persons experiencing any type of malnutritious state from excessive alcohol intake begin consuming high carbohydrate foods. The subsequent high demand by the cells for phosphate will deplete it from the bloodstream and consequently, create a deficit. Alchohol withdrawl can also induce respiratory alkalosis, another source wherein hypophosphatemia develops. Renal tubular disorders wherein reuptake of phosphates is experienced is another origin that would explain why you're being referred to nephrology, but let me caution you here that I've often observed physicians who react with such referrals based upon phosphaturia and consider the source of the hypophosphatemia to be related to a renal tubular defect. This is inaccurate and very common for some healthcare professionals to think of the terms as interchangable. They are definitely not and many conditions exist that can cause hypophosphatemia and most of those causes have nothing to do with overexcretion or phosphaturia. See? Okay, so if the nephrology appointment is 12 weeks off, then I'd suggest seeing a good internist or endocrinologist in the meantime. The reason is that the muscle symptoms you describe could be suggestive of ensuing rhabdomyolysis if conditions are suited, a disorder that can occur as a consequence of hypophosphatemia and one that requires immediate attention. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 7, 2009
    • 01:15 AM
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  • Unexplained weakness, fatiguability with little exertion. Morning, first thing out of bed is the worst! Feel weak and have the least amount of endurance out of the whole day. Climbing 2 flights of stairs will burn me right out. It's like my large muscles loose all power. Just moving after this simple exertion is impossible until I sit for a while. Achy back later in the day too. Have got low blood phosphates and my doctor has no idea. A four month wait to see a neuphrologist. Is this the right direction?Does anyone have ideas? How long have you been experiencing these symptoms? Do you have any history of asthma, bronchitis, or do you smoke? Any heart problems - high blood pressure/cholesterol/palpitations/ arrythmias? How old are you and are you male or female? How is your appetite? How is your digestion? Urination? Bowel patterns?Sorry for so many questions, but more info is needed. Best wishesDOM
    acuann 3080 Replies
    • January 7, 2009
    • 01:56 AM
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  • Thanks for the insite Dr. Cottle!I can assure you that my hypophophatemia is not at all associated with alcohol intake or withdrawal. And, no disrespect taken at all. I want to add that I have had a modestly elevated serum CK for a number of years and my phosphates have dropped even more over the last 2 years.
    kodger99 6 Replies
    • January 7, 2009
    • 02:08 AM
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  • Hi acuann, Here are the answers to your questions, I'm male, 41 yrs old, have somewhat elevated blood pressure, no /palpitations/ arrythmias that I know of. I have had this condition for a number of years and interestingly enough, 10 years prior to all this happening, I suffered from terrible distention that was never explained. When that went away, the current problem began. I had a huge weight shift from when I had the distention to now. From 190lbs then to 235lbs now. No history of asthma, bronchitis, or smoking either. Appetite is ok but doesn't seem to be as much as once was. Bowel habits and urination don't seem to be irregular.My hypophosphatemia has been documented since 2006, along with the above mentioned symptoms.
    kodger99 6 Replies
    • January 7, 2009
    • 03:15 AM
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  • Has your elevated CK been addressed?Have you had isoenzymes done?Have you had a muscle biopsy?Your symptoms sound like polymyositis.
    richard wayne2b 1232 Replies
    • January 7, 2009
    • 01:11 PM
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  • Has anyone thought about celiac disease? Take a look here: "Primary intestinal disorders, such as Crohn disease or celiac sprue, can limit phosphate absorption, leading to hypophosphatemia." At: http://emedicine.medscape.com/article/242280-overview And elevated CK: http://www.ncbi.nlm.nih.gov/pubmed/17667050?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
    aquila 1263 Replies
    • January 7, 2009
    • 08:27 PM
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  • My elevated CK is always considered "modest" and my hypophosphatemia tests anywhere from 0.62 to 0.85 in the normal range being 0.81-1.45. Usually the Dr responds "Huh". My Dr checked my blood pressure today; 150/100. Told me to come back in 2 weeks.In 2007 I had a parathyroidectomy. It corrected my calcium levels and it was supposed to do the same with the hypophoshatemia but it didn't.In regards to celiac's ....wouldn't I have diarrhea? I've never been tested for this though.
    kodger99 6 Replies
    • January 7, 2009
    • 10:11 PM
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  • Okay, well parathyroidectomy would have certainly been valuable information earlier in the discussion. So now we have a better clinical picture of what may be taking place. I would be interested to know whether you were diagnosed with hungry bone syndrome that may have delayed your discharge from the hospital post-surgery? We need to determine several things here. First of all, realize that hypophosphatemia can elevate calcium levels so in reviewing the labs it may be that your actual Ca is masked by this phenomenon. The second issue is whether you are losing phosphates in the urine. We need to determine vitamin D levels as well. It is possible that we may have a persistent hyperparathyroidism here that could be causing the subtle lab discrepancies. The muscle problem is definitely a myopathy and you need to be evaluated a little sooner than your earlier mentioned schedule. A nephrologist should indeed be involved to see if a renal tubular defect is present. I would start with the endocrinologist to run a series of labs that would determine the potassium, magnesium, vitamin D, Ca and the present serum phosphate. Also, urinalysis to determine whether phosphaturia is present. The answer can be elucidated but you'll need to move your physician beyond the stage of marveling at the inconsistency to seeking reasons why it exists. Incidentally, this is not due to celiac sprue. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 8, 2009
    • 00:51 AM
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  • Dr Cottle,Current labas are showing: corrected calcium 2.27 (2.10-2.60)ionized calcium 1.32( 1.17-1.32)serum phosphates 0.70 (0.81 -1.45)PTH 40 (7-50)None of the following: potassium, magnesium, vitamin DI was not diagnosed with hungry bone syndrome. I was discharged the same day aftre a double adenoma parathyroidectomy. Things improved for the first six months but then it has been down hill ever since.
    kodger99 6 Replies
    • January 8, 2009
    • 01:20 AM
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