33 week amenorrhea with sudden onset of severe breathlessness , EF 40,%, myocarditis , no CAD , no history of any comorbidity , BP 130/90, Pulse 120 , Respiratory rate 40 , gasping , intubated and shifted to icu On vent. please interpret the ABG. how to proceed

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ABG suggestive of Metabolic acidosis with respiratory alkalosis She mite a case of peripartum cardiomyopathy. Required extensive ICU management and immediately delivery. Ventilator support to be continued Chance of perinatal morbidity r high

ABG shows a Metabolic Acidosis (probably Lactic Acidosis) with Normal Anion Gap. In addition, ABG shows Hyponatremia, Hyperkalemia, Hypocalcemia and a raised Lactate. ECG shows P pulmonale with sinus tachycardia. Prima facie looks like a case of congestive heart failure precipitated by the myocarditis. Since patient is already on ventilator, adequate oxygenation coupled with a normocarbia should be the goal. Adequate IV fluids with correction of dyselectrolytemia is needed. Antibiotic cover to be provided. Inotropic support if required. Mother's health is of prime importance. Obstetricians need to be onboard and decide about need to deliver the baby. In my opinion pregnancy may be continued and health of mother monitored.

Uncompensated Non anion gap Metabolic acidosis. Either renal tubular acidosis due to ischemic damage to tubules but pottasium is usually low in that case and diarrhoea causing bicarb loss. Not able to compensate due to poor diaphragmatic movement due to third trimester pregnancy, obesity or altered sensorium may be will have to find the cause. ECG- sinus tachycardia P pulmonale Diffuse ST-T depression ( ant+inferior+lateral leads) aVR st elevation Left main coronary occulusion or Diffuse subendocardial ischemia or as you have already mentioned Myocarditis Hyponatremia - fluid retention in pregnancy or systolic dysfunction left ventricle Hyperkalemia- Metabolic acidosis reducing pottasium secretion

Metabolic acidosis Hyponatraemia Hyperkalaemia Hypocalcemia Hypochloraemia

Cardiac failure with bp 120/90(diastolic)=1=1=1,Abg met acidosis, no hypoxia (failure??? ) With lac 2.4. Stat BSL, urine ketone, Ddimer no usefull dont send, LFT, CXR, RFT,ntprobnp ,trop i Involve obgy, fetal monitoring, Ask detailed history vomiting, loos motion, level of conciousness, drousy n relatives given some thing to eat ( aspiration),ANC was doing or not whith whoom ask BP chek up,sugal level, temperature of pt

Metabolic acidosis Respiratory acidosis Hyponatremia Hypocalcemia Hyperkamemia Lactate raised Lactic acidosis Hyperoxia may be fio2,raised

Metabolic acidosis with electrolytes abnormal

ABG showed Metabolic acidosis with higher potassium. Renal perfusion has to be on lower side. From the history, gasping and shifted to ICU intubated, suggest the likely chances of pulmonary oedema. It's more likely a case of peripartum cardiomyopathy.

ECG of patient enclosed.please describe the ECG

P pulmonale

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Postpartum CMP

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