COVID 19 pneumonitis in Diabetic middle aged male.

50 years male, known diabetic, presents with history of severe dry cough, mild fever n SOB at rest for 3 days. On admission saturation was 70% on air. RR was 30/min Temp 98.8 BP 156/100 Pulse 112/min RS bilateral crackles Scattered rhonchi Blood investigations :- Leukocytosis Lymphopenia present N/L ratio 8 CRP 66 FERRITIN n D dimer awaited ABG shows severe hypoxia RFT n LFT are normal RBS 180 RT PCR for SARS COV-2 is Positive. HIS CHEST X RAY IS SHOWN BELOW. Discuss radiological findings. Discuss further management plan.

X ray chest shows bilateral lungs ground glass pattern - prominently seen in middle and lower lobe - it is typical of COViD 19 This patient has severe Hypoxia, raised CRP lymphopenia which indicate that he has severe disease Immediate target is to get oxygen saturation to normal, nonrebreathing mask, high flow nasal cannula are preferred way of administration of oxygen in order to improve saturation Non invasive ventilation is next in line, if oxygen saturation do not improve IV antibiotics can be given as there is leukocytosis, which insured m indicates infection Antiviral drugs role are debatable, none antiviral available to date has been proven to be effective Strict control of blood sugar - is single most important factor which can make significant improvement in this patient. I would prefer to use Glargine insulin which is looking acting insulin for control of blood sugar in critically ill patients Steroids to be considered in case oxygen saturation do not improve - as a part treatment of cytokine Strom Steroids cause increased blood sugar, hence patients in steroid will need higher dose of insulin treatment
Peripheral hazy chest presents ground glass appearance Consistent with covid19 positive test Pt is hypoxic as sp02 is 70% Lymphopenia is known presentation of covid Pt is hypertensive and diabetic Comorbidies at higher risk Put him on inj azithromycin Inj dexamethasone Inj Ceftriaxozone Inj bronchodilators Inj lasix Control bp and sugar What ecg suggest as most likely hit organ is heart myocarditis is known fatal complication Take care if hydroxychloroquine is given as azithromycin and hcq both increases qtc
Thanx dr Kute Ankush
Tnx Dr Shivraj Agarwal sir
Bil.pneumonitis.go for HRCT CHEST.& Covid 19 test

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