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Dr. Andrew Rynne

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Suggest treatment for headaches and change in vision

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Dr. Jnikolla

Pulmonologist

Practicing since :2003

Answered : 927 Questions

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Posted on Wed, 5 Apr 2017 in Lung and Chest disorders
Question: I have severe Primary Central Sleep Apnea. Went to the ER on Friday night with horrible headache and changes in vision. Headache is constant but the change in vision was new. Live in a constant brain fog. Dr. was transferring me to a hospital in Kansas City due to arterial blood gas test results, then decided to send me home, saying it is a chronic problem. Would like someone to interpret the test results for me.

TCO2 25.70, PH 7.54, RI -.20, PCO2 29.00, PAO2 113.00, SO2C GEM 99.50, PO2 147.00, HC03 27.40, FI02 21.00, BE 3.10, AADO2 -34.00
doctor
Answered by Dr. Jnikolla 1 hour later
Brief Answer:
Respiratory Alkalosis

Detailed Answer:
Hello and thank you for asking in HealthcareMagic,

I can understand your concern

In the arterial blood gases result it is an alkalemia and the process is called respiratory alkalosis with low Pco2 and high Ph values .

This happens usually in situation where the frequency of respiratory rate is high and the patient is with tachypnea.

Its causes are pulmonary and extrapulmonary ones.

But this situation are mainly due to extrapulmonary causes for example the central nervous system stimulation from several diseases as Central Sleep Apnea or obesity .

However it is not a urgent situation.

Usually it resolves with the treatment of the base disease, in your case using CPAP or BiPAP (as needed).

Do not worry so much

I wish a good recovery for you

Feel free to ask me again

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Jnikolla 46 minutes later
cpap nor bipap helped the situation. TSV dropped the AHI to 41. I am unable to drive due to my inability to focus. I have no short term memory. I see double sometimes. I live with a constant headache. I do feel a need to worry. I am being sent to a surgeon at the University of Oklahoma Hospital to receive a diaphragm pacer. My sleep dr has told me I am at a 35% risk of sudden death, so I do tend to worry about things like the ABG test. The ER doctor kept saying my "lungs were not working right" but then sent me home, so it is very concerning to me.
doctor
Answered by Dr. Jnikolla 13 minutes later
Brief Answer:
Please discuss with your doctor for further examinations

Detailed Answer:
Hi again

I am very sorry for your situation

According to the history you explain ,to explore the lungs, if i we're your doctor i would recommend you to do as follows :

Chest x Ray

Spirometry test to evaluate if there's an obstruction of airways which worsens the central sleep apnea more.

If it comes positive your doctor will prescribe you firstly aerosols with corticosteroids (Clenil) probably combined with bronchodilatators (Ventolin ) twice/d
for several days and after to continue with inhalers (Seretide).

It will help a lot .

Please discuss with your doctor about the above tests.

I am here to help you again.

Dr.Jolanda

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Jnikolla 24 minutes later
OK. I did have pulmonary function test and chest xray and ct of chest. All were normal. I guess I just don't understand the alkalosis, which is caused by fast respirations, when my problem is central sleep apnea and a lack of respirations. Seems I should be acidotic rather than alkaline. Would you mind to explain this?
I only sleep about 3 hours a night and the sleep study shows 50-70 episodes per hour. I always wake at 3 am. The test shows that my brain totally stops sending the signal to breathe at about 3 am. How can I be alkaline when it is brought on by fast breathing? Thanks for your help. Good night.
doctor
Answered by Dr. Jnikolla 19 minutes later
Brief Answer:
Mal stimulation of central respiratory centre

Detailed Answer:
Hi again

The fact that these tests results are normal is a very good thing because the pulmonary components which worsens more central sleep apnea are excluded. This is the reason that you are not acidotic fortunately.

In sleep apnea the central respiratory centre is over stimulated or mal stimulated with several disruptions of the cycle of breathing during the sleeping process.

If you are obese better to lose some weight. It will help you.

Hoping to have helped you

You are welcome anytime

I wish you a fast recovery

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Nagamani Ng
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