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What causes high levels of esophils?

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Practicing since : 2001
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Afib mostly at night just had an attack went to ER, panic attacks go with the afib, before or after it, not sure. low potassium 3.4 polyuria low spot/ast 12 low sgpt/alt 24 high globulin 3.5 high monocytes 9.3 high esophiles 8.0 high basophils 2.1 high #eos .6 high ventricular rate 110 to 140 calcium channel blocker was used ventricular rate 80 to 100 in 10 min ventricular rate XXXXXXX again in 2 hrs told doc felt dyhydrated from all the urination, also ask for something for the anxiety gave me 500ml IV, more calcium channel blocker, and ativan converted in 10 min was on beta blockers now on cal channel blockers never any diuretics I watch my sodium intake and eat 2-3 bananas or oranges a day and supplementing with about 700 mg of potassium 3 x day prior to this attack of afib, that why I don't get the low potassium. I am thinking hyperaldosteronism, would explain low potassium, polyuria, high blood pressure. asthma was under control during this attack only use albuterol occasionally, and symbicort if I get bronchitis. Any thoughts on the high levels of esophils? Thanks XXXXXXX
Posted Thu, 6 Feb 2014 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 1 hour later
Brief Answer: Hyperaldosteronism Detailed Answer: Yes I agree with you that Primary Hyperaldosteronism must be ruled. However, it would be worthwhile evaluating for the possibility of Pheochromocytoma as well. The eosinophils I believe can be a part of your asthmatic tendency but check with your pulmonologist. It is not related to the hyperaldosteronism nor pheochromocytoma. The best screening test for hyperaldosteronism is ARR (Aldosterone Renin Ratio) which entails performing 2 blood tests and then calculating the ratio: PAC / PRA = Plasma Aldosterone Concentrations / Plasma Renin Activity. This test is ideally supposed to be done mid morning after ambulating for a couple hours, and then sitting upright for 5-15 minutes. Fasting is not necessary. Further, the potassium must be normalized before doing this test. Hence take your potassium supplements adequately and check potassium on the same sample. During the days prior to the test, liberalize your salt intake because this is important. But monitor your blood pressure closely to make sure it does not rise sharply due to salt intake. There are specific requirements for the time of the blood collection to ensure the red blood cells dont 'hemolyse' giving a falsely high potassium reading. Generally labs are familiar with ways to accomplish this such as no fist clenching, waiting 5 seconds after tourniquet release to draw blood from the veins etc. If this test is abnormal, confirmatory tests will need to be done. A good screening test for pheochromocytoma is to check plasma fractionated metanephrines.
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Follow-up: What causes high levels of esophils? 4 hours later
Had ARR (Aldosterone Renin Ratio) came back normal. But did not follow any of the recommendations you listed, normalizing potassium etc. Question can AAR imbalances come and go? Leading me to be symptom free on some days and having symptoms on other days? Also had 24 hr urine test for pheochromocytoma came back negative as well. But was symptom free the day I took it. Question can this imbalance come and go as well? And be missed by the test? Should I ask for these test if I visit the ER again, the the height of an attack? Thanks XXXX
Answered by Dr. Shehzad Topiwala 8 hours later
Brief Answer: Yes Detailed Answer: It would be ideal to have the 24 hour urine collection on the same day as the 'spell'. However a 24 hour urine collection can have logistical challenges on that day, but it can be achieved. The screening test in blood can be relatively easier to do. Pheochromocytoma typically has this episodic presentation, but Hypealdosteronism is not associated with 'spells'. It is important to meet proper test conditions for this and so it would be worth repeating the way I described above. Alternatively, if you are doing a 24 hour collection anyway then talk to your endocrinologist to see if he can arrange an 'Oral Salt Loading Test' which is a confirmatory 24 hour urine collection to measure aldosterone along with sodium and creatinine. It requires some preparation such as adequate salt intake amongst oother things.
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