Chornic Hypercapnia

Just curious, do any of you have Chronic Hypercapnia and if so what kind of machine do you use? Does it help? What is the cause of your chronic hypercapnia? Over the past two years I've seen bicarb levels at 29, 32, 33, 27, and 34, in chronological order. The lab range is up to 301 I think. CPAP seemed to help for a bit but stopped. I breathe fine during the day with no trouble exercising, other than hypercapnia symptoms of aches and twitching. 30yo male with no history of smoking or symptoms of COPD. Will make appt with Pulmnologist but wanted to know your thoughts since I'm guessing many of you may have some insight here and thought I could get a head start. Thanks!

Unfortunately we don't get a lot of discussion here about hypercapnia. I know next to nothing about the topic---maybe even less than that. However, consistently elevated bicarbonate levels in the blood can indicate either poor lung function or poor renal function.

I'd see a pulmonologist to have lung function tested, but I'd also consider seeing a nephrologist to see what might be going on with kidney function. Good luck!

Maybe someone with more knowledge about this topic can chime in. If so, thanks in advance for sharing your knowledge.

My O2 seems to be ok during the day and at night according to the oximeter. Blood tests indicate that my kidneys are functioning well (Creatinine is well within limits). I'm guessing it's some kind of neurological problem thats causing hypoventilation.

Well, I definitely like your idea of seeing a pulmonologist. If hypoventilation is your problem, then end-tidal CO2 measurements can help corroborate that DX...

balor123 wrote:My O2 seems to be ok during the day and at night according to the oximeter. Blood tests indicate that my kidneys are functioning well (Creatinine is well within limits). I'm guessing it's some kind of neurological problem thats causing hypoventilation.

If a nonspecialist said your kidney function is fine because creatinine is okay, then perhaps they missed some other important renal tests:
http://en.wikipedia.org/wiki/Renal_phys ... l_function

So I'd see the pulmo first---especially if you're pretty sure you're hypoventilating. But if the pulmo doesn't pinpoint the etiology, then I think I'd still give the nephrologist a crack at DX. Supposedly high bicarbonate levels most often boil down to respiratory problems or kidney problems. Good luck!!

Check this report:

http://chestjournal.chestpubs.org/conte ... 1/218.full

I had blood lab values slightly out of range for several years, but so subtle that doctors paid no attention to them. Slightly high bicarbonate, hemoglobin, RBC. Turns out that for any individual one of those, even if it is out of range doctors don't really notice it until it is WAY out of range.

But I wonder if a new clinical symptom of SDB ought to be described--slightly out of range for certain blood values?

Thanks everyone for the replies. My father is an internist and my mother in law an academic vet. They aren't specialists so there may be renal impairment but neither thinks there's renal impairment based on what they see so far. More importantly though, the kidneys aren't the primary method of keeping bicarb low and they have limited ability to keep up from what I understand, especially with all these IgA and IgM running around keeping them busy. My mother in law thinks I may have compensation due to metabolic alkalosis - meaning there's no impairment in function at all but rather a problem causing the pH in my blood to be abnormal. I'm not remotely obese so OHS can't be an issue (in fact, I was flirting with borderline low weight for a while due to Gastroparesis). However, the pulmonologist suggested these things on the sleep study report.

Unfortunately, my primary care doctor chose to ignore his recommendations and decided not to do the pH test because he's convinced that I'm simply healthy and it's a mind-body problem that needs to be addressed. Like mentioned, they tend to ignore emergencies until they become disasters. I have lots of metabolic problems that seem to come and go on their own and he's just not interested. My dad wanted to do a lab xray originally but it was never ordered, which could have exposed lung damage if present a long time ago. I had an appointment with the Pulmonologist in Dec but my primary care suggested I only see the Neurologist since he thought I'd get more sympathy there so I cancelled the appt. Now I'll have to wait 2+ months to see him again and am just trying to figure out what to do in the mean time. I've also considered making appts with Nephrologist, Immunnologist, and even infection disease specialists. I don't think I can afford to wait the years necessary for the different specialists to figure this out as I'm getting worse in the mean time and it just takes so **** to get medical treatment. My dad said sometimes he has patients who need care so urgently he checks them into hospitals. I don't know why more action hasn't been taken against the ANA for this problem.

In any case, what does SDB stand for?

It sounds to me like you need to be looking for a new PCP. A very good PCP can save your life. None of your other doctors will have the big picture.

balor123 wrote:In any case, what does SDB stand for?

It stands for Sleep Disordered Breathing. I don't think the term OSA (obstructive sleep apnea) should be used for the diagnostic term any more, because many people diagnosed with OSA don't have obstructive apneas. "Sleep disordered breathing" covers more conditions, but even that is not general enough.

Yes I think so as well but my dad disagrees so I've deferred to him. Part of the problem is that MA has a big shortage of PCPs and referrals I've scoped out so far aren't accepting new patients. I'm considering boutique care now but haven't come to a decision. I think an SDB is possible given that the ENT looked in my throat and didn't believe the test results. I'm also not overweight. My sleeping habits were abysmal for about 10 years of my life (little sleep, bad, and inconsistent hours). I fixed them about 2 years ago but I think it was too late. I may have some nerve damage that is causing the throat to close or that part of my brain may just be throughly messed up by this point.

balor123 wrote:Part of the problem is that MA has a big shortage of PCPs and referrals I've scoped out so far aren't accepting new patients. I'm considering boutique care now but haven't come to a decision.

Well, do you mean Massachusetts when you say "MA"? No wonder you can't get a good PCP. It's hard to find a good anything in that state as it's medicine is cobbled up with cost issues and all the teaching hospitals (which will kill you too). A boutique Dr. is not really helpful. I've looked at some out here (way out west) and find that they are just bad PCP's who want to make more money by giving more bad care to their patients. $2K a year to get to see an internist whenever you want in a state that has institutionalized the non-practice of medicine is not helpful.

Now am I reading correctly that you have no symptoms other than relatively minor aches and pains - that you're breathing feels fine and you can exercise fine? Oximeter shows no problems and your kidneys look good? It may be that you are chasing one of these things for which there may never be an answer. If you had lung damage at 30, an oximeter would show a problem. If, as you say you have lots of metabolic problems that come and go - this may follow suit.

Elevated -HCO3 should not be considered to be hypercapnia-- rather, it is indicative of metabolic alkalosis.

The DIY Algorithm for MA (not "Massachusetts") is:

NotMuffy wrote:Elevated -HCO3 should not be considered to be hypercapnia-- rather, it is indicative of metabolic alkalosis.

The above chart was helpful IMO...

Also, my understanding is that hypoventilation can be the body's compensatory response to metabolic alkalosis. And I think in THAT physiologic scenario elevated CO2 can be more on the order of a tertiary symptom/response rather than secondary to this presently unknown etiology.

I've had urine analysis done several times this year but never Cl but in serum it's always ok. That's a great chart for differential - thanks! I don't have hypertension. No diuretics. This year I've had low potassium, phosphorus, and Vitamin D, though I took 8 pills of 50k IU in April and have continued with 800IU since. Now that I think about it, my bicarb dropped when I started taking PPI w/o sodium bicarb (Zegerid). My pillcam looked ok but given that I'm always short of electrolytes it's possible that gastric secretions just aren't being reabsorbed in the small intestines. The only symptoms of hypercapnea I have are muscular (exercise intolerance, muscle twiches, aches). I've read it can also cause neurological problems. I have unexplained cramps and pains at times and Gastroparesis, idiopathic of course, with mixed dysrhymia EGG (EKG for the digestive system). I'm suspecting that the bicarb is causing the Gastroparesis since it can cause muscle and neurological problejms. Next step might be urine Cl test then. My GI is suspicious that I have Celiac disease. My IgA-ttg is pretty elevated and rising (first time 30 then 47). Biopsy and pillcam were both negative however. Genetic test showed moderate risk. This may be one of those unexplainable cases but the only way to know is to try to explain it first. Every year for the past 3 years I've gotten worse symptomatically so I'm a bit concerned about the wait and see approach.