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What causes dizziness, fainting and weakness?

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Posted on Fri, 1 Aug 2014
Question: I have been having fainting and dizzyness/weakness. It usually only lasts a short time and everytime i get to the hospital every time is usually normal except for low blood pressure sometimes. My niece has insipidus diabetes and uses a refractometer so today when feeling well i tested myself and i was 1020, a couple of hours later i tested again and i was 1010, about an hour after that i was 1 notch above 1000 which is usually the point that my niece needs to take her medicine and i believe it means the salts are almost completely washed out. Would this explain my dizzyness, fainting and feeling unwell. As soon as i got that low i took those electrolytes rehydration sachets and i started feeling much better within a while and im back up to 1010 within about 2-3 hours. What doesnt make sense to me is that when it happens and by the time i get to the hospital maybe 1 hour later and they done bloods all my sodium, potassium etc were in range, after i get a dizzy spell and usually leading up to one i drink a ton of water and i usually need to urinate like 5-6 times an hour for an hour or two, then it normalizes again. I do drink a lot of water normally and have been keeping hydrated.
Also the other weird thing is i experienced the exact same thing maybe 12 years ago, it slowly seemed to disappear completely, maybe 5 years later i had one episode of feeling weak/faint/palpitations and then now recently 12 years after the first episode i have been getting these episodes every day or two for the last 2 weeks.

Usually i feel either a tightness in the chest or a mild nausea and generally just feeling unwell, usually during this period i have the urge to drink a lot of water, i dont know if its thirst or just that cold water makes me feel better when im like this, then sometimes it eases off and other times i feel like im going to faint, on one occasion a couple of months ago on a plane i did fully faint but not since but felt very close to fainting a bunch of times.

Afterwards and around the time i have trouble focusing, keeping a conversation, feel foggy/dizzy/lightheaded which can last a few hours or sometimes just a short while.
doctor
Answered by Dr. Shehzad Topiwala (3 hours later)
Brief Answer:
Diabetes insipidus

Detailed Answer:
I see what you are saying here.

The refractometer does not represent standard practice so I do not recommend it's use.

Some preliminary tests are necessary while we consider diabetes insipidus as a potential cause. We are essentially addressing your high water intake here.
It would be a good idea if you could quantify the amount of water you drink and the amount of urine you pass in a given 24 hour period. You will likely need to go to a nearby laboratory and collect a calibrated urine jar to ensure accuracy of collection.

Next blood tests are relevant. When I see someone like you I typically start with the following:
1 CBC
2 Electrolytes
3 Calcium
4 LFT
5 RFT
6 TSH
7 Free T4
8 Urine osmolality in a urine sample taken around the same time as the blood sample was drawn
9 Plasma free metanephrines

Further based upon the results of these, one can distinguish between the various potential causes of your complaints such primary polydypsia versus diabetes insipidus (central versus nephrogenic). These can be complex to dissect out and hence seeing an endocrinologist in person with the results will allow a systematic assessment of your problem.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala (5 hours later)
Ok thanks for the reply, while i understand the refractometer is not the standard and will try and get to a specialist for those tests you suggest i was hoping you could give me some more info.

Yesterday my urine density went from 1020 to 1002 over a 4-5 hour period, my understanding from reading is that 1005 to 1030 are normal ranges. 1000 basically means its completely water with no electrolytes etc

After taking diorilite which are electrolyte rehydration sachets it increased to around 1007 after around 40 mins. a couple of hours later it hit 1009 and this morning was back at 1007, then within 1.5 hours of that reading it dropped again to 1002, this is 2 days running.

What i would like to understand better is if this is normal. Yesterday i had maybe 3-5 pints of water, 3 of those sachets for rehydration and a 500ml bottle of sprite. This morning i had a pint of water, then 200ml of water with the sachets, i woke at 10am when it was 1007 and had the pint of water then and within 90 mins it was 1002 when i took the XXXXXXX before it went lower.

What could cause this to drop like this, all i done in that time was to walk down to the doctors maybe 5 mins away and back and i was sitting in the waiting room in between. Is there another possible cause that my sodium levels are dropping like this. Several other people in the house have taken the test and they are all ranging from 1012-1035 over several tests throughout the day.

To be honest inspipidus sounds unlikely because from reading people urinate very frequently, i only get that after getting an episode of feeling weak/dizzy then i will urinate 4-6 times per hour for maybe an hour or two and usually drink anything up to 2l of water within an hour of feeling well as the cold water seems to help so i drink as much as i can. Normally within 30-40 mins i start to feel better but now these sachets seem to be preventing it getting that far which is good.

doctor
Answered by Dr. Shehzad Topiwala (18 hours later)
Brief Answer:
Follow up

Detailed Answer:
I understand what you are saying.

However, please note that there is no published evidence based scientific medical guideline to go by the urine specific gravity, in analyzing your complaints.

I am not sure if this was deployed in previous decades but certainly in modern medicine the approach to your problems is largely with the help of universally standardized criteria that primarily include

Serum sodium
Serum osmolality
Urine osmolality

Based upon the results of these, it may be necessary to perform a Water restriction test

I am sorry I cannot guide on refractometer readings as they do not represent standard of care.

The internet can be misleading and lack credible information


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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What causes dizziness, fainting and weakness?

Brief Answer: Diabetes insipidus Detailed Answer: I see what you are saying here. The refractometer does not represent standard practice so I do not recommend it's use. Some preliminary tests are necessary while we consider diabetes insipidus as a potential cause. We are essentially addressing your high water intake here. It would be a good idea if you could quantify the amount of water you drink and the amount of urine you pass in a given 24 hour period. You will likely need to go to a nearby laboratory and collect a calibrated urine jar to ensure accuracy of collection. Next blood tests are relevant. When I see someone like you I typically start with the following: 1 CBC 2 Electrolytes 3 Calcium 4 LFT 5 RFT 6 TSH 7 Free T4 8 Urine osmolality in a urine sample taken around the same time as the blood sample was drawn 9 Plasma free metanephrines Further based upon the results of these, one can distinguish between the various potential causes of your complaints such primary polydypsia versus diabetes insipidus (central versus nephrogenic). These can be complex to dissect out and hence seeing an endocrinologist in person with the results will allow a systematic assessment of your problem.