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What causes dizziness, nausea, heart palpitation and black out?

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Posted on Tue, 12 May 2015
Question: This past weekend my boyfriend was out golfing and had some alcoholic drinks afterwards. Nothing more than his usaual golf outing. He had bkfst and lunch. The following morning he woke up not feeling well. He felt dizzy, clammy, nauseous, had palpitations,thinks he blacked out or had a seizure. He came to bed and his breathing became rapid. When I asked if he was ok he was unable to verbally respond. His eyes were moving side to side and he had a blank stare. I asked if he had any pain and was able to point to his chest. I called 911 and while prepping him for the hospital he had what appeared to be a seizure. EMS states he had another one in the ambulance. When arriving to the hospital he underwent a CT of the head w/o contrast which was normal. The blank stare and inability to respond verbally lasted for 6 hours, with bouts of rapid breathing and heart rate in between which would last for approx 5-10 seconds. CTA of the chest and abdomen along with a spinal tap, lyme testing, amonia level, and CMP normal. Alcohol level was 115. Fingerstick was 64 upon arrival to hospital. He was given glucose x's 1 and Ativan x's 2 for possible seizure activity. He was transferred to another hospital for a neuro consult and cardiac work up. EEG, ECHO and telemetry were all normal. No answers as to why this happened and im concerned it will happen again if we dont know why and can try and prevent it. He has a small adenoma on his pituitary gland and will be having a f/u MRI with contrast. Any suggestions? Also for the past 6 months he has had approx 6 flare ups of a new condition with a red rash on cheeks, around mouth and front of neck with small blisters that form around swelling lips. Has tried Benadryl and Zyrtec which both help but this seems to flare up when being in the sun and has never been an issue before. Not using any new products and not sure if this is all related to hospital visit but the rash flared up approx 4 days prior.
doctor
Answered by Dr. Dariush Saghafi (4 hours later)
Brief Answer:
Severe alcohol intoxication

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I'm a neurologist from the XXXXXXX OH area. Sorry your boyfriend had this happen to him. I'm sure you must've been rather alarmed at the whole ordeal.

The movement of his eyes you mention could've been a demonstration of a condition known as Positional Alcohol Nystagmus (PAN) and the blank stare obviously a sign of reduced status of alertness, possibly a seizure of some type but more likely a state referred to as STUPOR. Recall, the EEG was negative for seizure or post seizure activity.

You also mentioned that he was dizzy, clammy, nauseous and had a rapid heart rate as well as rapid (and likely shallow breathing). These symptoms suggest what is referred to as DYSAUTONOMIA and are seen frequently in cases of alcohol intoxication and near posisoning.

Do you know what any of his blood pressure readings were during this whole time because those are generally very low but can fluctuate to exceedingly high?

Now, to a very important piece of data from the labs; alcohol level of 115 (BAC of 0.115) which was hours after his last drink, correct? At least that is my interpretation since you mention that it wasn't until the next morning after coming home from the golf club that he started with these symptoms and the lack of responsive.

The legal limit of intoxication for the purpose of driving is considered 0.1 and so he was over the limit. But here's the thing....that was his Blood Alcohol Concentration (BAC) when he awoke and was taken to the hospital. What was it hours before when he was at the country club? Based upon the autonomic symptoms, his state of alertness, inability to speak, nystagmus, and other symptoms BAC charts suggest that he may have been originally between 0.3-0.4 which is very high.

Since he's been worked up for stroke, seizure, metabolic derangements and none were really found then, the most likely source of problem was the elevated alcohol and the 115 is the smoking gun. The skin rash you mention is the initial stage of what are called "angiomas" or spider veins which are commonly seen as the initial manifestation on the skin of liver disease commonly associated with alcohol abuse. Red rash manifestations can also be seen as part of initial liver disease and primarily occurs on the upper chest, neck, and face (mainly cheeks) and can be caused by and exacerbated by UV radiation from sunlight.

I would forward the possibility that your boyfriend needs to consider speaking with a professional well versed in alcohol abuse because he just showed you a whole lot of them over the course of a few days.


I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (18 hours later)
Good Afternoon Doctor,
Im having some difficulty responding on this app through my phone. Many pop ups. I wanted to thank you for your feedback. The rash that comes n goes on his face appears to be more of an allergic reaction to something.

Just wanted to give an update on the drinking. Yes, i agree with your diagnosis. I pretty much calculated the bac in the same area as you for where was at after his last drink. He does have a problem when around his friends n this time of yr. He does not however drink everyday n does not drink all winter long when coaching basketball except for an occassional 1 or 2 drinks if we go out for dinner. He will have 1-2 drinks one night during the wk with dinner and then on a fri or saturday night after golf is when he goes way over board n doesnt know his cutoff. he doesnt get drunk every weekend, maybe 1 time a month this time of the yr. I have asked his primary care doctor in confidence to address this issue at his f/u. Im surprised that all of the physicians in the hospital didnt mention that it was even the slightest bit related to the events that took place until i read the reports n was quite upset that they hadnt when i saw the level. Its been a sensitive issue to talk about with him n feel he will respond better when discussing with his primary. Thank you again for your feedback.
Sincerely, XXXX
doctor
Answered by Dr. Dariush Saghafi (9 hours later)
Brief Answer:
Sorry you and he are dealing with this-- wish there were an easier way

Detailed Answer:
Since I don't know anything more about the rash on his face I'll have to accept your evaluation that it is an allergic rash, however, I think it is possible that this could be an early warning sign as well for the beginning of liver disease, sometimes referred to as fatty liver. If you feel it is allergic somehow then, you will have to strive to identify the trigger and either desensitize to that trigger or have prescription medications given to take if he breaks out....so either a dermatologist or allergist should be consulted. I would also consider taking pictures of the breakouts when they occur.

As far as the drinking is concerned....your description was classic for alcohol intoxication and the numbers don't lie. I don't quite understand how so many doctors involved in the case could just turn a blind eye to that diagnostic possibility even after seeing a BAC by report ABOVE the legal limit hours after his last drink. That floors and irks me at the same time. It's a shame that nobody of the medical profession wanted to take the time or had the courage to bring up the tough issues because my feeling is that your boyfriend probably has a bit of a strong personality...he's a coach, a golfer, what the heck...a few drinks with the boys....goes to the hospital, and soon as he wakes up he's trying to get dressed to go home, right?

Well, all I can say is that he will look back at these days of opportunity to change course with regret if he passes the point of no return and there isn't much anybody is going to do to prevent that from happening. He needs to come to the realization that he simply drinks too much...period....no other excuses about not drinking during the season, and only binging on weekends.....the whole thing is not acceptable because the effects on his body are evident. I fear you may empower him a bit if you also use those lines of justification and support.....I think you'll get more mileage and a better outcome from him if you paint the picture as black and white. It'll give him less wiggle room to look for ways to breach what needs to be done....which is essentially suspend the drinking. In the state he was in that you described his chance of having a fatal intoxication event was on the order of 20-30%. Of course, nobody gave you those figures at the hospital because those folks didn't even want to admit that there was a problem....they wanted to do scans and a whole bunch of other tests either to skirt the issue or rack up XXXXXXX to the insurance companies...Nice....I am quite offended by such practitioners who take advantage of people and mislead them for their own financial gains.

I honestly think the hospital completely and perhaps even willfully misdiagnosed him and if it were me...I'd call them on it....that diagnosis could've been made by a first year resident in training let alone multiple attendings just passing him on to another consultant. The fact of the matter is someone ordered the alcohol screen test....why didn't they look at the results and act on them?

Back to the patient=== He needs to get into a program OR he can do it on his own if he's got the discipline but he has to have the desire...simple as that....if he doesn't recognize the problem for what it is then, I'm afraid he may hurt himself and others, both physically, mentally, and financially.

I wish you and he the best.

I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask and assuming that I wasn't totally offensive in my comments that I state simply because I am best understood (so I'm told) when I'm to the point and direct.....

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

Cheers--- without raising the glasses though! LOL.

The query has required a total of 82 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

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What causes dizziness, nausea, heart palpitation and black out?

Brief Answer: Severe alcohol intoxication Detailed Answer: Good afternoon. My name is Dr. Saghafi and I'm a neurologist from the XXXXXXX OH area. Sorry your boyfriend had this happen to him. I'm sure you must've been rather alarmed at the whole ordeal. The movement of his eyes you mention could've been a demonstration of a condition known as Positional Alcohol Nystagmus (PAN) and the blank stare obviously a sign of reduced status of alertness, possibly a seizure of some type but more likely a state referred to as STUPOR. Recall, the EEG was negative for seizure or post seizure activity. You also mentioned that he was dizzy, clammy, nauseous and had a rapid heart rate as well as rapid (and likely shallow breathing). These symptoms suggest what is referred to as DYSAUTONOMIA and are seen frequently in cases of alcohol intoxication and near posisoning. Do you know what any of his blood pressure readings were during this whole time because those are generally very low but can fluctuate to exceedingly high? Now, to a very important piece of data from the labs; alcohol level of 115 (BAC of 0.115) which was hours after his last drink, correct? At least that is my interpretation since you mention that it wasn't until the next morning after coming home from the golf club that he started with these symptoms and the lack of responsive. The legal limit of intoxication for the purpose of driving is considered 0.1 and so he was over the limit. But here's the thing....that was his Blood Alcohol Concentration (BAC) when he awoke and was taken to the hospital. What was it hours before when he was at the country club? Based upon the autonomic symptoms, his state of alertness, inability to speak, nystagmus, and other symptoms BAC charts suggest that he may have been originally between 0.3-0.4 which is very high. Since he's been worked up for stroke, seizure, metabolic derangements and none were really found then, the most likely source of problem was the elevated alcohol and the 115 is the smoking gun. The skin rash you mention is the initial stage of what are called "angiomas" or spider veins which are commonly seen as the initial manifestation on the skin of liver disease commonly associated with alcohol abuse. Red rash manifestations can also be seen as part of initial liver disease and primarily occurs on the upper chest, neck, and face (mainly cheeks) and can be caused by and exacerbated by UV radiation from sunlight. I would forward the possibility that your boyfriend needs to consider speaking with a professional well versed in alcohol abuse because he just showed you a whole lot of them over the course of a few days. I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments to ask...however, I'm hoping you come back with more information but of course, that is entirely up to you. Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary. Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.