Here is something to think about.....

I am running a low bicarbonate, well borderline low...one more tick and it is below normal. I was reading up on this, and it seems that if one runs a low bicarb, one is more susceptible to osteoporosis, and basically bone breakdown....I wonder if this could make one more susceptible to neuropathy....given diabetes generally results in ketoacidosis---different yes, but still acidosis.

People with this run low Vit. D as well, and usually don't absorb dietary or supplements until the bicarb issue is fixed.

My bmp is trending towards distal renal tubular acidosis type 1 (high chloride, low bicarb, low K, low Ca, normal anion gap). This comes with Sjogren's, but, perhaps could be a result of ivig due to hypergammaglobulinemia?? Don't really know I guess. But, I also drink reverse osmosis water which has no alkalinity? Perhaps my dietary intake of alkaline food and drink is low or else my kidneys are just not making bicarb as they should..... Or, I am falling apart.

Anyway, any thoughts on metabolic acidosis and small fiber....any one else have low bicarb? MRSD, you probably are familiar with this?

Some drugs may do this... Topamax for one.

I really don't know about the kidney aspect... but low bicarb can be corrected with Sod. Bicarb tabs..and this is common in some older patients.

Low bicarb also impacts digestion, since the pancreas needs it to neutralize stomach acid as food enters the small intestine.

Acidosis can give lots of paresthesias too.

Most of the kidney stuff is beyond me. It is very complex.
There is a new poster on the boards...who got kidney problems from IVIG... I'll try to find him and link here to his post.~~

Here it is:
http://neurotalk.psychcentral.com/sh...highlight=IVIG
new members cannot send PMs...but they can receive them. To answer they have to hit the reply button on your PM to them. So if you contact this poster privately, you need to explain that to them.
Or you can just answer that thread.

They do a BMP and GFR on me every month. My labs are only trending not over the limit yet...I watch trends.

I did read a link on low vit. D, osteopenia, osteomalacia, associated with low bicarb. It sounds like a lot of people can have a subclinical acidosis.

Anyway, as long as the kidneys hold, then the ivig will continue. It is a lot of protein to excrete and I am sure it takes a toll. It seems to me, they could mitigate the low bicarb before it is a problem.

I've been thinking....

If you are using Miralax frequently, I'd stop and see if things improve. The FDA is watching this product along with 18 other drugs for post marketing issues.

It is polyethylene glycol, and glycols are implicated in acidosis.

Nope....no Miralax. I gave that up in lieu of fresh veggies. Thanks, you must have really checked this out for me! I am leaning toward this distal renal tubular acidosis thing. My mom and grandma had horrible osteoporosis, and it makes me wonder if we have some issue. I believe my mom had some unidentified autoimmune disease....and my dad's family was loaded with it.

Anyway, thank you. I was just kind of wondering if the acidosis, even tho a different mechanism than ketoacidosis, may be responsible for neuropathy, and I am wondering if I should go ahead and do a bit of sodium bicarb. Docs seem unconcerned, but, they don't get concerned until AFTER the damage is done.

Bicarb is used for "some" but not all acidosis. So be careful with it if you do it. The kidney doctors decide basically.

The kidney acidosis is much different from the diabetic one.

And yes, there are nerve issues...paresthesias...with acidosis.
Tingling and pain may occur depending on severity.

OK, so this thread is coming out of storage.....

My labs dumped into full blown abnormality. Low K, Low Ca, Low Bicarb. High chloride. Normal anion gap. That equals distal renal tubular acidosis. My arterial blood gases were abnormal. One BMP was normal and the blood gases abnormal, which makes me wonder how long this has been going on and the BMP normal.

Interestingly this ties into vit. d, which last spring, was LOW.

This ties into parathyroid...aldosterone...oh, way too much for my brain. My brain flies out the window when acid-base stuff surfaces, and I have no intention of learning this stuff, if I can at all help it.

My neuro wants me to continue ivig. I disagree....until this is addressed. I am afraid of stressing my kidneys more. ivig can always be restarted-kidney tissue can not be replaced. My cardio wanted me to increase cardizem prior to this issue, now he d'cd. it. Which I agree with.

My rheumie told me I have fibro and she was so nasty last visit in Spring, I declined to see her again. (Fibro with an ANA of 1>1280? and a million abnormal tests??) Other docs say Sjogrens. I need a new rheumie?? I am limited by insurance. Besides what are they gonna do? They don't know manure from shoe polish. They do more harm than good.

GI has been stagnant, and I go vasovagal with intestinal cramping which occurs intermittently (diverticulosis?). Doing nothing is the wisest course, so it's me and my benefiber and my pillow and the bathroom floor...

I pee like a racehorse. I waiver in the wind....and generally feel weak and hung over. I went off all meds except for vicodin 5mg and my
.125mg pramipexole....and K+. So it's not meds.

Something is not right.....I see a nephrologist in a week....ugh....

I knew I wasn't feeling well before this surgery and I should have waited....now I fear the abnormal labs will interfere with bone healing....

I see that dRTA is associated with hypermobility syndromes such as Ehlers-Danlos or Marfans, and I am flexible and one of my kids is almost freakshow material....altho an extremely good athlete.....so, now I am off to medical genetics too...

Ughffff, I opened pandora's box. Where and how the PN fits in is still a question.

I found the end of the earth....it isn't round....I am clinging to it with my fingernails!

I am very sorry to know of this Cy... what is it with AI disease and SFN??!!

Hello Cyclops,
I came upon your thread and felt I should respond.
I was diagnosed with dRTA by the Mayo Clinic about 5 years ago. It is very important that if you do have RTA you get started on meds to get rid of the acidosis. It can have a number of bad effects on your body. If you have this the continued acidosis of your body will continue to damage your kidneys. Have you had any kidney stones? This is what made me aware of the disease. An MRI showed calcified deposits in my kidneys. Please go see a nephrologist. There is a definitive test for dRTA, I dont remember the name but its a timed test regarding the pH of your urine. A urologist is not good enough, mine missed it. Had I not gone to Mayo I dont know how long it would have taken. I cannot repair my kidneys but I take potassium citrate twice a day to regulate my body. The energy level is much better with the medicine. It really drags you out.
As I read your post I could really sympathize. Not long after the RTA diagnosis I was diagnosed with Fibro, possibly CFS, and now have Sjogrens.
I take a number of meds and go to a weekly message (muscle ) therapist once per week. I often feel crummy but am functioning. Not nearly at the level before my illnesses but I wont give up my life for this.

Good luck - see a nephrologist. Please.

Thank you. I have an appointment with a nephrologist. I am concerned about the acidosis.

I have a lot of flank pain....which I thought was the result of disc disease, but, the last MRI, showed no discs out....hmm.

I AM going to see the renal doc, at an academic center, and also medical genetics.

I am diagnosed with Sjogren's, but do not have the +SSA or SSB....I am leaning toward a possible genetic cause of the dRTA. Have you had any genetic studies done? There is one European ethnicity, and only one, that shows a rare specific blood type associated with dRTA....and my ancestry is 50% from this group. I plan on having this tested. This blood marker is common in Mongolians, and it would have been the last place I would have looked for an abnormality, given my maternal side seemed very heterogenous....Heterogeniety apparently really doesn't matter when something is autosomal dominant.

I may be off on another wild goose chase, but, I am a detective of sorts....I want the RIGHT answer....no matter how long this takes. I want the correct diagnosis so my kids don't have to do this chase. If it is not hereditary...great....if it is, well, at least I found it.

Did you know dRTA comes with Sicca?

It is hard to know what is what with Sjogren's because it is cavalierly diagnosed....until all possibilities are ruled out....I will reserve judgment, and that is hard, because I so want to figure this out.

Again, thanks.