A morbidly obese female aged 55 years p/w complaints of Severe Breathlessness , Cough with Expectoration and Fever since 4-5 days....She is a known Hypertensive and Diabetic on treatment...Her respiratory rate was 32/min and Diffuse Rhonchi were present on auscultation...comment on her reports and approach to this patient

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Pt is morbidly obese Having multiple comorbidies htn DM2T P/w roncji and tachyopea Xray chest shows cardiomegaly Rt lung is hyperinflated and trachea is pulled to rt Lt lower zone is hazy Ecg shows ventricular ectopics Abg suggest respiratory alkalosis Possibly pt has pericardial effusion with copd and comorbidies Hence 2decho hrct to confirm Manage by niv O2 support Broadspectrum antibiotics Treat alkalosis by sodabicarb Keep htn and diabetes under control with relevant treatment Diuretics Sos tapping for diagnostic treatment
Sir can we treat alkalosis by sodabicarb
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Bilateral basal hazy more so on lt side with obliteration of cp angle Though xray quality is not so good what I can interpret is cardiomegaly with pulm oedema with? Pl effusion lt side Irregularly irregular rhthym with sinus arrest and ant septal ischemia Oxygen Diuretics Antibiotics Bronchodilators Nebulization Digoxin vil be helpful Serial ecgs Electrolyte monitoring
Neutrophilic leucocytosis with fever and diffuse rhonchi favour lower respiratory tract infection in dm ...but raised level of proBNP suggest heart failure ....so it is case of most probably DCMP with LRTI ...
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Ecg suggest low voltage reading and cheat. Xay shows cardiomegaly ....it might be DCMP
Cxr s/o lt sided pleural effusion,pro bnp is increased indicating chf,ecg shows junctional arrest. Breathlessness is d/t chf causing pleural effusion. ABG report?? Sputum for afb,cbnaat If hypoxic then give O2,nebulisation Lasix to clear chf,inj lanoxin for chf,syp ascoryl for cough,inj ceftriaxone,inj pcm,tab amlong 5 mg for BP,and antidiebetic for diabetes Monitor BP,rbs and look for any source of sepsis
Normal pH is 7.35 to 7.45 so pH 7.424 is normal Normal pco2 is 35 to 45 which is 56.5. High PCO 2 causes respiratory acidosis not alkalosis. Normal HCO3 is 24 which is 36 in this case. In acute compensation HCO3 will lead to 25-26 in chronic 30. Compensation is never complete. So it's a mix disoder Respiratory Acidosis & Metabolic alkalosis
Cxr... Cardiomegaly and bilateral congestion(CCF) . Left lower zone opacities(?r/o pneumonitis) Haemogram... leukocytosis Ecg... LAD LAHB Occasional VPC's Abg Metabolic alkalosis with partial compensation
DM with HTN with CHF Pneumonitis 2D echo Insulins basal Bolus Broad-spectrum antibiotics Diuretics If COPD component go for Bronchodilator and expectorant Best Go for BARIATRIC SURGERY IF POSSSIBLE
Ecg LAD LAHB PVC X-ray Cardiomegaly with bilateral Pleural effusion
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