[24M] With hyperventilation, vertigo, and muscle twitches

Patient Description

A 24-year-old male has been experiencing hyperventilation episodes for the past 2 days, occurring once a day while working over hot fryers. Each episode lasts about 15-20 minutes and comes on suddenly. During these episodes, the patient feels very close to fainting and experiences tingling (pins and needles) in the face and feet, with the face going pale. The patient also reports random muscle twitches, vertigo for the past few weeks, and a high-pitched roaring sound in both ears rated as 6 out of 10 in intensity. The vertigo affects balance and coordination. The patient experienced a headache early in the morning that lasted for about 6 hours. The patient recently ran out of ADHD medication (27mg Concerta and 10mg Ritalin) about a week ago and has been slow to get a refill. Additionally, the patient recently used molly, cocaine, and ketamine at a party and has quit smoking weed and tobacco, noting an increase in appetite and some irritability after quitting tobacco. The patient has a history of kidney stones, with the last occurrence about a year ago, and suffered from syncope as a baby. Currently, the patient is taking Ritalin, Concerta, and Glycopyrrolate, all once a day.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses and unifying conditions that could explain your symptoms:

Hyperventilation, Lightheadedness, and Near-Fainting

  • Panic Attacks or Anxiety: Hyperventilation, lightheadedness, and near-fainting can be symptoms of panic attacks or anxiety, especially if triggered by stressful situations like working over hot fryers. The tingling and numbness in your face and feet are also common in hyperventilation due to anxiety.
  • Heat Exhaustion: Working over hot fryers could lead to heat exhaustion, which can cause hyperventilation, lightheadedness, and fainting. Pallor and muscle twitches can also be symptoms of heat exhaustion.

Vertigo and Ringing in Ears

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition can cause vertigo and is often accompanied by a sensation of fullness in the ears and ringing. It is usually triggered by changes in head position.
  • Meniere's Disease: This inner ear disorder can cause vertigo, ringing in the ears (tinnitus), and a feeling of fullness in the ears. It can also affect balance and coordination.

Muscle Twitches

  • Electrolyte Imbalance: Muscle twitches can be caused by an imbalance in electrolytes, which might be related to dehydration or changes in diet, especially after quitting substances like weed and tobacco.
  • Medication Withdrawal: Stopping ADHD medications like Concerta and Ritalin suddenly can lead to withdrawal symptoms, including muscle twitches and increased irritability.

Headaches

  • Medication Withdrawal: Headaches can also be a symptom of withdrawal from ADHD medications or other substances like tobacco and weed.

What you can do

Hyperventilation, Lightheadedness, and Near-Fainting

  • Stay Cool: Try to stay cool while working over the fryers. Take frequent breaks to cool down and stay hydrated.
  • Breathing Techniques: Practice deep breathing exercises to help manage hyperventilation. Inhale slowly through your nose, hold for a few seconds, and exhale slowly through your mouth.
  • Seek Medical Advice: Consult a healthcare provider to discuss your symptoms and potential anxiety or panic attacks. They may recommend therapy or medication to help manage anxiety.

Vertigo and Ringing in Ears

  • Avoid Triggers: Try to identify and avoid triggers that worsen your vertigo, such as sudden head movements.
  • Vestibular Rehabilitation: Consider vestibular rehabilitation exercises, which can help improve balance and reduce vertigo symptoms.
  • Consult an ENT Specialist: See an ear, nose, and throat (ENT) specialist to evaluate your vertigo and ringing in the ears. They can perform tests to diagnose conditions like BPPV or Meniere's disease.

Muscle Twitches

  • Stay Hydrated: Ensure you are drinking enough water and maintaining a balanced diet to prevent electrolyte imbalances.
  • Medication Management: Consult your healthcare provider about your ADHD medication. They can help you manage withdrawal symptoms and discuss the best way to resume or adjust your medication.

Headaches

  • Hydration and Rest: Stay hydrated and get plenty of rest. Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage headache pain.
  • Consult a Healthcare Provider: Discuss your headaches with a healthcare provider, especially if they persist or worsen.

What you should look out for

Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe or Worsening Symptoms: If your symptoms become more severe or do not improve with self-care measures.
  • Fainting or Loss of Consciousness: If you experience fainting or loss of consciousness.
  • Severe Headache: If you develop a sudden, severe headache that is different from your usual headaches.
  • Chest Pain or Shortness of Breath: If you experience chest pain or shortness of breath, seek emergency medical care immediately.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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8 mo ago

Top picked over-the-counter products for Tingling or Cold Sensations at the Back of Your Head

People Also Ask


What are the common symptoms of heat exhaustion and how can it be prevented?

Common symptoms of heat exhaustion include heavy sweating, weakness, dizziness, nausea, headache, and muscle cramps. To prevent it, stay hydrated, take breaks in cool areas, and wear lightweight clothing when working in hot environments.


How can anxiety or panic attacks cause hyperventilation and what are some coping strategies?

Anxiety or panic attacks can cause hyperventilation by triggering rapid breathing, which leads to an imbalance of oxygen and carbon dioxide in the body. Coping strategies include practicing deep breathing exercises, mindfulness, and seeking therapy or medication if needed.


What are the potential causes of vertigo and ringing in the ears?

Vertigo and ringing in the ears can be caused by conditions such as Benign Paroxysmal Positional Vertigo (BPPV), Meniere's disease, or ear infections. These conditions often affect the inner ear and can impact balance and hearing.


What are the withdrawal symptoms from stopping ADHD medications like Concerta and Ritalin?

Withdrawal symptoms from stopping ADHD medications like Concerta and Ritalin can include fatigue, depression, irritability, headaches, and muscle twitches. It's important to consult a healthcare provider for guidance on managing withdrawal and adjusting medication.


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