Q. I am feeling shaky, clammy and flushing often. How to know the reason for these symptoms?

Answered by
Dr. Shinas Hussain A P
and medically reviewed by iCliniq medical review team.

Hi doctor,

I am 46 years old. My weight is 147 lbs and height is 5'3". I am currently taking Tizanidine, Nabumetone, and Hydrocodone as prescribed for a back injury sustained over three years ago. My symptoms are extreme shaking, severe weakness sometimes to the point of feeling like I am about to pass out, nausea, vomiting, clammy, incredibly sweating and flushing. It happens about two to six times a day for a week and then goes away for roughly one to three weeks. I would like to know the reason for those symptoms. Should I visit my doctor immediately?

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Dr. Shinas Hussain A P

MBBS
Family Physician General Practitioner

Hello,

Welcome to icliniq.com.

I have gone through your query, and I can understand your concerns.

  • I think you had a back injury, pain, and spasticity (stiffness) for which you are taking the above mentioned drugs for last three years. Let me explain briefly about the drugs you are taking.
  • Nabumetone is a relatively safe drug and side effects are very minimal apart from mild gastritis and nausea.
  • Tizanidine is a muscle relaxant, and it is used for stiffness. Long-term use of Tizanidine for years can cause some adverse effects like dizziness, vomiting, extreme fatigue, confusion, etc. So, your symptoms can be due to adverse effects of Tizanidine.
  • Hydrocodone is an analgesic and is used for pain conditions. The side effects are similar to Tizanidine.
  • Your problems could be due to the side effects of your pain medicines. But before making a definite diagnosis, we have to rule out some other condition.
  • I suggest you consult a general practitioner and do the following to rule out some other condition which can have symptoms similar as in your history.
  1. ECG to rule out coronary artery disease.
  2. Serum electrolyte assay to rule out hypokalemia and hyponatremia.
  3. Check your blood pressure level to rule out hypotension and hypertension.
  4. Check your blood sugar level.
  5. All other investigations as prescribed by your treating physician which might include a CT head and upper GI endoscopy.
  • As of now, you can do the following the following: Drink plenty of water, avoid unwanted stresses be calm and relaxed, get adequate sleep and healthy diet and consult your doctor for nausea and vomiting.

The Probable causes:

Adverse drug reactions.

Investigations to be done:

ECG, serum electrolytes, RBS (random blood sugar) and CT head.

Differential diagnosis:

1. Coronary artery disease.
2. Electrolyte imbalance.

Treatment plan:

Conservative.

Regarding follow up:

Revert with the reports to a family physician online.---> https://www.icliniq.com/ask-a-doctor-online/family-physician

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