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What Causes Extreme Weakness?

Posted on Mon, 3 Nov 2014

Question: I very good friend on mine has experienced over the past weeks, extreme weakness just walking to her desk, cries a lot due to not knowing what is going on. She has had blood work done and has seen her dr a number of times and they can't find anything wrong. she is bipolar and takes Lithium and Neurontin. Her blood work is coming up with nothing they can determine. She is very scared as she has never had this happen. She is only 35 years old, not over weight. Could this be due to some lack of vitamins as she does not take any. She has a occasional glass of wine and just quit smoking a few months ago. Any idea what might be going on?

Answered by Dr. Chintan Solanki (1 hour later)

Brief Answer:
May be vitamin B12 deficiency, provide more detail

Detailed Answer:
Hello,

Thanks for writing to us.

I appreciate your concern for your friend.
From your narration I can say it may be Vitamin B12 deficiency causing such type of weakness.
Another possibility is withdrawal of smoking habit.
To think about other possibilities I need some more detail.

Please send her all blood reports.

Since when she is on lithium? Dose of lithium?

Her smoking details: Duration, quantity and frequency and is it relation with stopping smoking and symptoms started.

Some detail about her food habit.

Mention detail about her weakness

Waiting for your reply to guide you more specifically.

Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Chintan Solanki (14 hours later)

Thank you so much for your response. I will ask XXXXXXX today if she has her blood work results and forward them to you on Monday.
She use to smoke a pack a day for the last 10 or 12 years. She quit cold turkey.
When she gets in to work, I will have her come to my office so we can answer these questions more in detail. I would like her to put in her words the details.
Again thank you and we will get back to you if not today - on Monday.

XXXX will be sending me her blood results. The other answers to your questions:
She has been on Lithium since Feb 2011 - started with 900mg and now is taking 1200 mg starting a month ago. Her diet is not so great - she did just start eating red meat again, but skips a lot of meals. I told her she has to eat breakfast and something at lunch and dinner with a lot of vegetables and grains. She indicated that her weakness go in episodes of 30 minutes to 2 hours everyday. Can hardly walk a block, Use to be able to walk 3-4 miles a day. Can't do it anymore. I will forward blood results when she sends them to me. My computer at home took a fall, so the only access I have currently is the one at work. I only work till 11:00 on Fridays - Monday thru Thursday 7-4:30. Thank you so much for your assistance in this. XXXXXXX XXXXXXX

Answered by Dr. Chintan Solanki (10 hours later)

Brief Answer:
Could be withdrawal features

Detailed Answer:
Hi XXXXXXX

Thanks for some info.

As your friend had left smoking suddenly , possibility of withdrawal features are there. However in most of the patients withdrawal comes to normal in 2-3 months.But in few patients it lasts longer.

Lithium has very low therapeutic window.It means slight lower than optimum level it is not useful and slight higher than the optimum, there will be side effects.I suggest go for her serum lithium level.

Her diet is irregular and that is an additive factor to the problem.

And last but not the least from her symptoms ,"weakness go in episodes of 30 minutes to 2 hours everyday, can hardly walk a block " I guess it may be some neuropathy related changes.

Waiting for reports.

Regards,
Dr.Chintan Solanki.

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Above answer was peer-reviewed by : Dr. Raju A.T