<s>[INST] Hello doctor, Experience episodes of extreme weakness, lethargy, tiredness, unable to get out of bed + going to the bathroom often at night. Two years back had ecg-proven vtach after an episode went on for several days. Have had labs done close to two episodes. A month back carbon dioxide was slightly low at 19 with trace blood in urine and USG 1.005 and urine ph 7. Second one recently again this month had mild low bicarbonate. [/INST] Hello. I went through your reports and labs that you sent (attachment removed to protect patient identity), You have one report showing slightly low normal potasium level of 3.8. V tac can be because of low potasium level. There can be condition called as distal renal tubular acidosis for which check urine sodium, potasium and chloride and creatinine and we have to calculate urinary anion gap. Also, since how long you are taking Methotrexate? </s>