A 60 yr old male who is a chronic smoker presented with Breathlessness, pedal edema , poor oral intake and personality changes since 5 days....vitals at presentation were BP-160/100 PR-106/min, spO2-85%, Rbs- 88....No h/o any comorbidity..comment on the approach to this patient...



This pt is critically ill.pt is air hunger as protrusion of tounge says.presence of ketone bodies and hyponatrimia i.e. ketoacidosis.at the same time 2d echo shows gross Lv dysfunction Lvef is 35 to 40 % only usg also shows hepatomegaly with mild ascitis or interloop collection.pts x-rayis informative.lt side shows gross pl effusion with collapseof the lt lung and on rt sidecanon ball opacities are visible with dense shadow in rt middle and hilar region.mediastinum is in centre.pt is chr smoker predisposing factor for malignancy.ecg is not posted. I shell treat this pt as ca lung with lvf since he is hypertensive he must be on anti hypertensive drugs. Fisrt treat ketoacidosis put him on iv diuretics maintain p02. Tap pleural effusion sent for confirmation condition improves i will start lanoxin.he seems to be nondiabetic. Sofar hepatomegaly is concerned that is secondary to long standing chf.

Thanx dr Nsv Nair

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This is Dialated Cardiomyopathy with Congestive Failure with dyselectrolytemea. Rationed Fluid, Diuresis, Crrection of Dyselectrolytemea in a slow mode. Statins and Antiplatelets. Selective Betablockers ( in a guarded fashion under contentious monitoring).

Echo finding is not s/o Cardiomyopathy

CCF....Ischaemic cardiomyopathy...Diuretics...Correction of dyselectrolitemia..Anti platelets and statins...Tovaptans for hyponatremia...Close monitoring.

Kindly see echo...there is no e/o cardiomyopathy

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This is a case of COPD,CAD, biventricular hypertrphy, CHF , dyselectrolytemia,multiorgan involvment with respiratory ketoacidosis Tx O2 inhalation Digoxin in low dose. Elecrolyte supplements Diuretic ( potassium sparing) Sodabicarb according ABG report NTG drip in low dose cause benefit in cardiac function and act as diuretic

Also add broad specrum antibiotic coverage

Hyponatremia, hypokalemia, CO2 retention( hypoxia) responsible for metnal status: Correct them: RBS normal : ketoacidosis present: ?starvation: IV dextrose, oral feeding: KFT is normal but USG sggest Mild paranchymal disease: iv fluids will take care so also correction of Elites. CXR suggest bilateral extensive pneumonia with cavities on Rt side with bilateral pleural effusions; Broad spectrum antibiotics (sputum gram, AFB, staining & culture: Echo suggest Corpulmonale: Bp control with low dose Lasix/ amlodepine: JVP monitroing

Can lanoxin be prescribed right now in this low potassium??

Sir i said first correct the ionic balance and yes pts lt ventricular functions are vary poor we have to restore as early as possible yes you will have to keep monitoring as well including potassium

Looking at clinical featurs & provided reports appear to be caze of ccf with reduced EF 'ascites .on xray could be lt siddd pleural effusion or pneumonitiS .Treatccf with o2 & diuretics.Thenre assess

This pt. Needs very extensive investigation, like CXR to exclude chest malignancy, gastroscopy for any stomach pathology,cardiac investigation to exclude CCF control of BP. AND in. View of personality changes C,T scan of brain.and treat the causes.

X- ray shows pleural effusion encapsulated needs to be drained and examined could be tubercular or malignant.

Ketoneuria hyponatremia Ards bilateral effusion with Koch's heart failure PAH lt basal pneumonitis

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